Infections caused by Cladosporium spp. are rare in humans and are generally associated with opportunistic processes in immunocompromised individuals or prolonged environmental exposure, particularly in tropical regions. These are dematiaceous, filamentous, pigmented fungi widely distributed in the environment, which rarely cause invasive infections and are more often implicated in allergic or cutaneous conditions. Mucosal involvement is considered atypical and is poorly documented in the literature, making diagnosis and clinical management difficult. We report the case of a 64-year-old female, previously healthy, with a history of rural work, referred to our service with a diagnostic hypothesis of mucosal leishmaniasis. For approximately one year she had progressive left-sided nasal obstruction, associated with oropharyngeal secretion, dry cough, dysphonia, and dyspnea on minimal exertion, without fever, weight loss, or other systemic symptoms. Otorhinolaryngological evaluation showed an ulcerated lesion in the adenoid region and crusting on the left nasal septum. She also brought an external serologic test with reactive IgM for leishmaniasis. Biopsy of the lesions was performed; histopathology showed a chronic ulcerated inflammatory process. Mycological culture grew Cladosporium spp., while a molecular test performed on the collected material was negative for Leishmania spp. Bacterial and mycobacterial cultures were also negative. CT of the paranasal sinuses showed nonspecific inflammatory changes, without evidence of fungal invasion. Based on the mycological finding and exclusion of other etiologies, itraconazole 400 mg/day was started, with outpatient day-hospital follow-up and periodic otorhinolaryngology reassessments. This case highlights the relevance of including uncommon fungal infections in the differential diagnosis of atypical chronic nasosinusal conditions, especially in patients with significant environmental exposure. Given the scarcity of reports of mucosal infection by Cladosporium spp., clinical follow-up may contribute to better understanding of disease evolution and the effects of systemic antifungal therapy.
Almeida et al. (Sun,) studied this question.