Case report
White piedra: further evidence of a synergistic infection

Presented by Dr Youker at the 59th Annual Meeting of the American Academy of Dermatology, Washington, DC, March 2-7, 2001.
https://doi.org/10.1067/S0190-9622(03)00459-6Get rights and content

Abstract

White piedra is a fungal infection of the hair shaft caused by Trichosporon beigelii. A synergistic coryneform bacterial infection is often present with T beigelii. White piedra, although not commonly reported to infect scalp hair in North America, is an important consideration in the differential diagnosis of scalp hair concretions. We report a case of white piedra of scalp hair with synergistic coryneform bacterial infection in two sisters, both US natives. Culture and light and electronmicroscopic evidence of the synergistic infection are presented.

Section snippets

Case 1

doi:1067/S0190-9622(03)00459-6 An 18-year-old white woman presented with a 5-month history of asymptomatic “white spots” on her hair. She had not recently traveled outside of the United States, but had a partner from Mexico. Clinical exam revealed discrete, white, adherent nodules scattered throughout her hair (Fig 1, A). No scalp erythema or alopecia was present. Genital hair, eyelashes, and eyebrows were clinically unaffected. A potassium hydroxide mount revealed nodules consisting of a mass

Specimen culture and identification

A sample of patient hair specimen was placed into a sterile petri dish and sectioned with a prepackaged sterile scalpel. The sectioned hair concretions were placed into approximately 1.0 mL 0.1% Tween 80 and planted to (1) a Sabouraud dextrose plate (BBL Microbiology Systems, Cockeysville, Md) and incubated at 25°C to recover yeast/fungi; (2) a sheep blood plate (BBL); and (3) a chocolate plate (BBL). Both of the latter two plates were incubated at 35°C to recover bacteria. All diphtheroid

Discussion

Beigel first described white piedra (Spanish for “stone”) in 1865 after observing white, adherent nodules on the hair of a wig.3 Vuillemin isolated the causative, yeast-like fungus from moustache hairs in 1902 and named it T beigelii.4 T beigelii is primarily considered a soil inhabitant. White piedra is a fungal infection of the terminal hair shaft that is generally seen in semitropical and temperate climates such as South America, Asia, and Europe. It primarily affects the genital, moustache,

Acknowledgements

We thank Rosemary Walsh and Michelle Peiffer of the Electron Microscope Facility for the Life Sciences in the Life Sciences Consortium & Biotechnology Institute for their preparation and interpretation of scanning electron microscopy specimens.

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Conflict of interest: None identified.

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