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By Sanjay G. Revankar, MD, Professor of Medicine and Director, Infectious Disease Fellowship Program, Division of Infectious Diseases, Wayne State University School of Medicine ; Jack D. Sobel, MD, Dean and Distinguished Professor of Medicine, Wayne State University School of Medicine

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Phaeohyphomycosis refers to infections caused by many kinds of dark, melanin-pigmented dematiaceous fungi. It is distinguished from chromoblastomycosis and mycetoma by the absence of specific histopathologic findings.

Pigmented fungi have been increasingly recognized as opportunists, causing phaeohyphomycosis in immunocompetent and immunosuppressed patients. Phaeohyphomycosis can be caused by many species of dark, melanin-pigmented dematiaceous fungi including Bipolaris, Cladophialophora, Cladosporium, Exophiala, Fonsecaea, Phialophora, Ochronosis, Rhinocladiella, and Wangiella.

Dematiaceous fungi only rarely cause fatal infections in patients who have intact host defense mechanisms, although they may cause brain abscess in immunocompetent patients.

Clinical syndromes include invasive sinusitis, sometimes with bone necrosis, as well as subcutaneous nodules or abscesses, keratitis, lung masses, osteomyelitis, mycotic arthritis, endocarditis, brain abscess, and disseminated infection.


  • Examination using Masson-Fontana staining

  • Culture to identify causative species

Dematiaceous fungi can frequently be discerned in tissue specimens stained with conventional hematoxylin and eosin; they appear as septate, brownish hyphae or yeast-like cells, reflecting their high melanin content. Masson-Fontana staining for melanin confirms their presence. Phaeohyphomycosis is distinguished from chromoblastomycosis and mycetoma by the absence of specific histopathologic findings such as sclerotic bodies or grains in tissue.

Culture is needed to identify the causative species.


There is no standard therapy; treatment depends on the clinical syndrome and status of the patient.

For subcutaneous nodules, surgery alone may be curative. Itraconazole has excellent activity and has been used the most clinically, although voriconazole and posaconazole are being increasingly used with good results. Duration of therapy varies but may range from 6 wk to > 12 mo. Amphotericin B is often ineffective.

Combination therapy (eg, with 2 or 3 drugs, at least one of which is an azole) for brain abscess and disseminated infections is often used, although clinical outcomes are generally poor regardless of treatment.

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