Exserohilum

Clinical Manifestations

• Opportunistic pathogen in the immunocompromised, including aplastic anemia and HSCT
• Causes keratitis, sinusitis, cutaneous, and subcutaneous infections
• Of note, in 2012, it caused an outbreak of fungal meningitis associated with contaminated steroid injections (source was the compounding pharmacy)

Diagnosis

• Culture
  • Colony: Growth is rapid and colonies are woolly and gray to black in color
  • Microscopy
    • Hyphae are septate and dematiaceous
    • Conidiophores are geniculate as a result of sympodial development
    • Conidia may be straight, curved or slightly bent and are distinguished by having prominent, protruding hila

Management

• Amphotericin B, itraconazole, voriconazole, and posaconazole have all been used successfully1
• An expert group has recommended voriconazole for CNS disease based on very little data