Authors' reply.

Sir,

In response to our report on Scedosporium apiospermum sinusitis in a patient following prolonged anti-TNFα therapy,[1] Dr. Monika Matlani has brought to our notice about a case of Scedosporium prolificans osteomyelitis in an immunocompetent child. Scedosporium infection has been reported in both immunocompetent and immunocompromised subjects. However, Scedosporium is mostly an opportunistic fungus.

In recent years, an increasing number of cases of human disease with S. apiospermum have been reported, probably due to widespread use of corticosteroids, immunosuppressants, antineoplastics and broad-spectrum antibiotics. Thus, it is essential for dermatologists to be aware of clinical presentations and diagnosis of Scedosporium infection.

Cutaneous manifestations of Scedosporium infection are protean. In most cases, inoculation of spores in the cutaneous and subcutaneous tissues is due to penetrating trauma or surgery. Scedosporium spp. infections can present as papules, erythematous plaques, folliculitis, necrotic papules, cutaneous ulcers, nodules, subcutaneous abscesses, and ulcers in a sporotrichoid (lymphangitic) pattern, ecchymosis, and hemorrhagic bullae.[2-4] Thus, the cutaneous manifestations are nonspecific and can be misleading in respect to the underlying disease. In appropriate clinical scenario, specifically in immunocompromised patients, physicians need to be suspicious for Scedosporium and other opportunistic infections. On occasions, a specific diagnosis of Scedosporium infection may require repeated biopsies, specific fungal staining, and fungal culture.