Discovery of Itraconazole Responsive Gene Regulation in Clinical Isolates of Purpureocilium lilacinum

Discovery of Itraconazole responsive gene regulation in clinical isolates of Purpureocilium lilacinum

Minju Jeong1, Geon-Jong Lee2, Kyung-Hwa Nam2, Seok-Kweon Yun2, Jin Park2,*, Kyung-Tae Lee1,*

1 Korea Zoonosis Research Institute, Jeonbuk National University, Iksan 54531, Jeonbuk, Republic of Korea

2 Department of Dermatology, Jeonbuk National University Medical School & Hospital, Jeonju, Korea

3These authors contributed equally

4Correspondance to airmd@jbnu.ac.kr to J Park, lee.kt@jbnu.ac.kr to K-T Lee

Keyword

Purpureocillium lilacinum, Paecilomyces lilacinus

Abstract

Purpureocillium lilacinum, formerly Paecilomyces lilacinus, is a saprophytic fungus found in soil and rotting vegetation and rarely pathogenic to humans. Only a few cases of cutaneous infection caused by P. lilacinum have been reported in the name of P. lilacinus. Herein, we report four cases of localized cutaneous infection due to P. lilacinum. Clinically, four adult patients presented single or multiple erythematous to violaceous deep-seated nodules on their upper and lower extremities. Routine laboratory examination and chest x-ray findings were non-contributory. Histopathologic examination from the skin lesion showed suppurative granulomatous inflammation with hyphae and round spores in the dermis in all four patients. The isolates showed extremely high resistance to amphotericin B, 5-flucytosin, and caspofungin. Among azole drugs, voriconazole was most effectively inhibited the hyphal growth and sporulation. Interestingly, itraconazole treatment induced the sporulation of P. lilacinum differently from other azoles. In this study, ICZ-induced expressional changes in signaling factors were identified through gene expression analysis.