Vascular Pythiosis Caused by Pythium Aphanidermatum: The First Case Report in Asia

Abstract Background: Pythium, soil-borne plant pathogens, are in the class Oomycetes. They are not true fungi, but are related to diatom and algae. There are 2 human pathogens including P. insidiosum and P. aphanidermatum. To date, only 1 case of pythiosis caused by P. aphanidermatum has been reported. We present herein the first case of P. aphanidermatum vascular pythiosis in Asia.Case presentation: A 47-year-old Thai woman, living in North Thailand, with ß thalassemia/hemoglobin E presented with acute recurrent arterial insufficiency of both legs. Emergent embolectomy with clot removal was performed. The pathology of the clot exhibited noncaseous granulomatous inflammation with many fungal hyphal elements. PCR identified P. aphanidermatum with 100% identity. Finally diagnosis is vascular pythiosis. Unfortunately, inoperation due to extensive abdominal aorta involvement, the patient eventually expired after treatment with itraconazole, terbinafine, azithromycin, and doxycycline.Conclusions : To date, only 1 case of pythiosis caused by P. aphanidermatum has been reported. We present herein the first case of P. aphanidermatum vascular pythiosis in Asia.