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 presents the first documented case of a DFU caused by S. apiospermum from Pakistan. A 65-year-old male with a 20-year history of diabetes mellitus, hypertension, and ischemic heart disease presented with two non-healing ulcers on his left leg. Examination and lab testing revealed generalized body edema and ulcers with purulent discharge. Pus and tissue samples from the shin ulcer were cultured on Sabouraud's dextrose agar, leading to the identification of S. apiospermum based on macroscopic and microscopic features. The patient was treated with oral voriconazole, along with 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.