Article Text

Download PDFPDF
Dematiaceous fungal infections: clinical and pathologic conundrums
  1. Emily Mae Hartsough,
  2. Ruth K. Foreman,
  3. Maria Martinez-Lage,
  4. John Branda,
  5. Aliyah R. Sohani,
  6. Lawerence Zukerberg
  1. Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Emily Mae Hartsough, Pathology, Massachusetts General Hospital, Boston, MA 02114, USA; ehartsough{at}


Dematiaceous fungi are defined by pigment within their cell walls. They are increasingly recognised human pathogens, causing a wide range of clinical presentations, from localised subcutaneous infections to disseminated disease in rare cases. We report our institutional experience with diagnosis of dematiaceous fungal infections from 2005 to 2022 and highlight four instructive cases that clinically and pathologically mimicked other diseases for which the diagnosis was confirmed by fungal culture (one case) or supported by PCR with 28S rRNA and internal transcribed spacer primers (three cases). Two patients were immunocompromised and two had presumed exposure to the organism. In each highlighted case, fungal infection was not clinically suspected, and the pathologist was critical in making the diagnosis and ensuring appropriate clinical management, which was supplemented by fungal stains and novel molecular methods.

  • pathology, surgical
  • microbiology
  • fungi

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Vikram Deshpande.

  • Deceased LZ deceased

  • Contributors LZ and AS conceptualised the manuscript and assisted with writing and editing. EMH pulled cases, performed literature review and drafted the manuscript. RF and MM-L contributed cases to the manuscript and assisted with editing. JB assisted with slide and morphological review of the organisms. LZ unexpectedly passed prior to the completion of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AS is consulting for AbbVie. RF is associated with Fate Therapuetics, Inc.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.