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01.12.2015 | Case report | Ausgabe 1/2015 Open Access

BMC Oral Health 1/2015

Antifungal susceptibility and phenotypic characterization of oral isolates of a black fungus from a nasopharyngeal carcinoma patient under radiotherapy

BMC Oral Health > Ausgabe 1/2015
Chaminda Jayampath Seneviratne, Phoenix HL Fong, Sarah SW Wong, Victor HF Lee
Wichtige Hinweise
Chaminda Jayampath Seneviratne, Phoenix HL Fong and Victor HF Lee contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CJS and VHFL conceived and designed the study. VHFL performed the sample collection. PHLF performed the experiments. CJS, PHLF, SSWW analysed the data. CJS, PHLF, SSWW and VHFL wrote the manuscript. All authors read and approved the final manuscript.



During a research project on fungal Candida species in patients wearing obturator treated with radiotherapy for their recurrent nasopharyngeal carcinoma, we serendipitously observed the presence of black fungus in two consecutive samples from a patient.

Case presentation

The samples were collected from a 57 year-old Hong Kong gentleman who diagnosed to have undifferentiated type of nasopharyngeal carcinoma. He was treated with definitive concurrent chemoradiotherapy followed by adjuvant chemotherapy and then received a second-course radiotherapy with IMRT. 18S rDNA sequencing revealed that the isolates belong to Exophiala dermatitidis which was susceptible to fluconazole, itraconazole, ketoconazole and voriconazole. Interestingly, E. dermatitidis isolates were resistant to caspofungin and one isolate was resistant to amphotericin B. Both isolates formed biofilms comparable to that of Candida albicans. Single isolate of E. dermatitidis showed hemolysin and proteinase ability comparable to C. albicans whilst the other isolate was not.


We, for the first time, reported the discovery of a black fungus–E. dermatitidis isolates derived from a patient with nasopharyngeal carcinoma treated with radiotherapy. These isolates were shown to be resistant to caspofungin, a major antifungal agent for systemic candidiasis. As little is known about the black fungus in the clinical setting, it is important that clinicians must keep abreast of the new discovery in this field.
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