Sir,Opportunistic subcutaneous fungus infections arecurrently increasing in incidence, partly due to thegrowing number of patients receiving immunosuppres-sive therapies. Accordingly, these infections, formerlymostly encountered in hot and dry areas, are now morewidely distributed and may challenge clinical andbiological diagnosis when occurring in areas wherephysicians are not accustomed to them. We report onthe first case of non-mycetoma deep cutaneous infec-tion due to Pyrenochaeta romeroi, a rarely isolatedagent only reported in mycetomas to date, in animmunocompromised patient originating from westernAfrica.CASE REPORTA 45-year-old patient was first referred to our depart-ment for evaluation of non-inflammatory, painful anddeep lesions of both lower limbs reminiscent of coldabcesses. He originated from Senegal and had beenliving in France for the previous 10 years. His medicalhistory was remarkable for a multibacillary leprosytreated by sequential antibiotics for more than 20years, with painful neurological sequelae for whichhe self-administered intramuscular dexamethasone ona monthly or bi-monthly basis. Clinical examinationshowed a large subcutaneous, flaccid lesion of thelateral side of the left leg, of at least 4 years’ duration,with an occasional purulent white-yellow dischargethrough superficial sinus tracts, a 2-cm-large noduleof the right tibial crest and two crusted papulo-nodulesof the left foot. No discharge of granules was seen fromthe main lesion. A four-limbs distal hypoaesthesia wasotherwise obvious, likely related to the post-leprosyneuropathy. Biological tests revealed an inflammatorysyndrome (ESR 86 mm at first hour, C-reactive protein189 g/l (normal: 0–5 g/l), a rise in WBC (14.10
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Girard et al. (2004) studied this question.