Rare lower extremity invasive fungal infection in an immunosuppressed patient: Exserohilum longirostratum

Infection with E. longirostratum is exceedingly rare in both immunocompetent and immunocompromised patients and has not been previously reported as a cause for extensive lower extremity ulceration. We report a single case of invasive E. longirostratum infection of the lower leg in an immunosuppressed patient with severe liver disease. Treatment of this case consisted of systemic antifungal therapy with voriconazole, aggressive serial surgical debridements, the placement of multiple split-thickness allograft dressings, and formal wound closure with split-thickness autograft. At the time of followup, the patient was still awaiting a liver transplant, his leg ulcerations were fully healed, and he had no recurrent disease.