Scedosporium apiospermum infection in a non-healing diabetic foot ulcer patient: First report from Pakistan

ABSTRACT

Diabetic foot ulcers (DFUs) are a common and challenging complication of diabetes mellitus, often resulting from neuropathy, vascular insufficiency, trauma, and infection. Fungal infections, though less commonly recognized than bacterial infections, can contribute to non-healing ulcers. Scedosporium apiospermum, an emerging opportunistic fungal pathogen, is a rare cause of skin and soft tissue infections, especially in DFUs. To the best of our knowledge, this report describes the first documented case of a DFU caused by S. apiospermum in Pakistan. A 65-year-old man with a 20-year history of diabetes mellitus, hypertension, and ischemic heart disease presented with two non-healing ulcers on his left leg. Physical examination and laboratory evaluation revealed generalized edema and ulcers with purulent discharge. Pus and tissue specimens obtained from the shin ulcer were cultured on Sabouraud dextrose agar, resulting in the isolation of Scedosporium apiospermum, which was identified based on its characteristic macroscopic and microscopic features.

The patient was treated with oral voriconazole, in addition to wound care and regular dressing changes, and scheduled for follow-up. This case emphasizes the importance of considering rare fungal pathogens, such as S. apiospermum, in the differential diagnosis of non-healing DFUs, especially in patients with multiple comorbidities. Mycological evaluation should be performed in diabetic patients with chronic non-healing ulcers, particularly when antibacterial therapy fails. Accurate identification of the fungal pathogen is crucial for appropriate antifungal therapy, as S. apiospermum exhibits resistance to many conventional antifungal agents. A multidisciplinary approach, including glycemic control, wound care, and targeted antifungal therapy, is essential for successful management.

Keywords: Scedosporium apiospermum, Diabetic foot ulcer, Diabetes mellitus, Mycology, Culture