Diagnosis: Syncephalastrum racemosum
• Syncephalastrum racemosum is a ubiquitous, saprophytic fungus found in soil and decaying plant debris. It belongs to the order Mucorales and has been reported as a rare cause of systemic and nail infections.
• S. racemosum may resemble Aspergillus or Fusarium spp. on microscopic examination because all three can show dichotomous branching, often at a 45-degree angle. In contrast to the numerous septate hyphae of Aspergillus or Fusarium spp., Syncephalastrum is sparsely septate. Phialides, which are specialized cells that produce conidia (conidiogenous) without increasing length, are absent in Syncephalastrum.
• Left ventricular assist devices (LVADs) can be used to salvage a patient in cardiogenic shock and can be used as a bridge to transplantation. The devices are equipped with alarms if they malfunction. Should there be an obstruction, the parts should be cultured and the source of the contaminant investigated.
• The identification of filamentous fungi by phenotypic methods includes colonial and microscopic morphology, biochemical tests, and growth on differential media. Culture remains the gold standard for mold identification, but it is cumbersome, technically challenging, and has a prolonged turnaround time for results. Molecular methods are increasingly used for fungal identification due to increased sensitivity, ease of use, and rapid results.
• There are only limited data regarding treatment of Syncephalastrum infections. Amphotericin B, ketoconazole, and itraconazole minimum inhibitory concentrations (MICs) are low, whereas those of voriconazole are relatively high.