Diagnosis and Treatment of Chronic Skin Infection Caused by Scedosporium apiospermum

This case report presents a 77-year-old male with purplish-red, blister-like lesions on the right forearm. A background of long-term corticosteroid therapy for pemphigus led to significant immunosuppression. Initial laboratory investigations, including bacterial and fungal cultures as well as histopathological analysis, yielded inconclusive results. To identify the causative pathogen, next-generation sequencing (NGS) was performed on tissue samples, which confirmed the presence of Scedosporium apiospermum, a rare opportunistic fungus. Based on this result, a targeted treatment strategy was implemented, involving multiple surgical debridements and systemic antifungal therapy with voriconazole. The therapeutic response was favorable, with complete resolution of the infection and no signs of recurrence during an 8-month follow-up period. This case highlights the clinical value of NGS in diagnosing rare and atypical infections, particularly in immunocompromised settings where conventional methods may fail. It also underscores the importance of a multidisciplinary treatment approach that integrates timely surgical intervention with appropriate antifungal therapy to achieve optimal patient outcomes.