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A 67-year-old man, with multiple skin lesions that appeared over 2 years, had biopsies that disclosed granulomatous dermatitis with associated small yeasts. The urinary antigen test results were negative for Histoplasma infection; cultures from the biopsies did not grow any fungi or other potential pathogens. The chest roentgenogram results were normal. Morphologic examination revealed features of a Malassezia species. Broadrange fungal polymerase chain reaction and DNA sequencing disclosed that the infecting fungus was Malassezia sympodialis, a lipid-dependent yeast. This report supports one other case report that Malassezia species may cause granulomatous dermatitis; in the previous case, the etiologic agent was Malassezia pachydermatis, a nonlipid-dependent species. We recommend the use of lipid-supplemented culture media for specimens from patients with granulomatous dermatitis because several Malassezia species are dependent on lipid; the absence of lipid supplementation in routine cultures likely explains the negative culture results for this patient. This, to our knowledge, is the first report of granulomatous dermatitis caused by M sympodialis.
(Arch Pathol Lab Med. 2011;135:1085-1087)
Malassezia species are round to oval, often ''bowling pin'' shaped, yeasts that are routine microbiota and opportunistic pathogens of the skin of humans and domestic animals. Named for Malassez, who first described them in 1874, these yeasts demonstrate monopolar budding1 The base of the bud is commonly described as broad, and, although not always discernible, a collarette composed of residual cell wall material may be seen at the base of the bud.2 These yeasts are commonly seen in the keratin layer of the epidermis of skin biopsies and, in most instances, are simply commensal skin microbiota.
Malassezia furfur is the most commonly recognized Malassezia species in humans.2 It is a cause of tinea versicolor and fungemia, the latter of which is usually associated with an intravenous catheter infection and, in some instances, with a lipid-rich hyperalimentation infusion.2 Human infections by Malassezia species other than M furfur have been reported, such as, for example Malassezia pachydermatis.1,3 We report for the first time, to our knowledge, on a patient with granulomatous dermatitis due to Malassezia sympodialis.
REPORT OF A CASE
The patient was a 67-year-old man with cutaneous lesions on the back, chest, and neck. These lesions were biopsied over 2 years; the patient also had a history of multiple cutaneous...