Photodynamic Therapy as a Key Adjunct in the Multimodal Management of Cutaneous Fusarium solani Infection in an Immunocompromised Patient: A Case Report.

Abstract

Fusarium solani (F. solani), a ubiquitous environmental fungus and common phytopathogen, rarely causes cutaneous infections in humans-particularly in immunocompromised individuals, where it may lead to severe or disseminated disease with poor prognosis. We report a 60-year-old male with myelofibrosis on long-term ruxolitinib therapy, presenting with progressive cutaneous granulomas on the left thumb (duration: 6 weeks) and back (duration: 2 weeks). The diagnosis of cutaneous fusariosis was established based on clinical presentation, combined with fungal culture, morphological characterization and molecular identification of the pathogen from lesion exudates, crusts and excised tissue specimens obtained from both lesions. Multimodal therapy was initiated: empirical itraconazole combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for the thumb lesion, and surgical excision for the back lesion. Notably, although antifungal susceptibility later revealed itraconazole resistance, the patient showed marked improvement during combination therapy with itraconazole and PDT. Based on susceptibility results (terbinafine MIC < 0.03 μg/mL), the antifungal regimen was switched to terbinafine plus PDT. Complete remission was achieved with no recurrence at 6 month follow up. This case suggests that the multimodal regimen-combining systemic antifungal therapy, local ALA-PDT and surgical excision-may be an effective strategy for managing refractory cutaneous F. solani infection. However, the independent therapeutic contribution of ALA-PDT cannot be determined from a single case report.