Surgery plus photodynamic therapy for a diabetic patient with cutaneous infectious granuloma caused by Curvularia lunata

Curvularia lunata (C. lunata) can be easily found in environment and plants and rarely causes human infections. Antifungal agents have been the primary approach to treat such infections; however, adverse hepatotoxic reactions may require discontinuation of the long-term use of antifungal agents in patients with pre-existing liver diseases. New therapeutic approaches are thus needed to cope with these circumstances. Here, we report a 66-year-old diabetic female patient, suffering from a rapidly growing lesion on the nose for 2 months. The patient was diagnosed with cutaneous fungal infection caused by C. lunata, which was based on mycological study and ITS sequencing. The lesion was completely disappeared after a combination of surgery and 3 times of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) at 9- day intervals. The patient did not receive any antifungal agents during the treatment. There was no recurrence at 6-month fellow-up. In the following in vitro study, C. Lunata growth was significantly inhibited by ALA-PDT treatment. Therapeutic success in this patent suggests that the ALA-PDT method could be a promising treatment for cutaneous fungal infection caused by C. Lunata and others. © 2022