A 4-year-old girl presented with a 2 years history of verrucous hyperplasia vermiculatum in the right cheek. KOH mount of the skin scrapings was negative for fungal elements. Culture from the biopsy material grew a white mode. The isolate was identified as Fusarium lichenicola based upon morphologies and phylogenetic tree analysis which was created based on the analysis for translation elongation factor 1α (TEF1α) gene of 43 Fusarium species. The drug susceptibility test showed the MICs to be 0.25ug/ml for AmB, 2ug/ml for voriconazole and posaconazole, >64ug/ml for 5-Fc, and >16ug/ml for Itr. We started treatment with intravenous amphotericin B (AmB) with initiated dose of  0.1 mg per kg of body weight per day and increased to 0.8mg/kg on day 7 and maintained for a total of 750 mg for 65 days.  Then the girl was treated with injections of intralesional amphotericin B (2.5mg/L) in the outpatient department every one or two weeks for 10 times with little improvement. Followed treatment with oral voriconazole (50mg bid) and the lesion is getting improved with reducing infected area till now. In previous cases of infection caused by Fusarium lichenicola, this species has been characterized as causes of keratitis (5 cases), mycetoma (1 case), athlete’s foot (1 case), scaly lesions in the webspaces (1 case), localized invasive lesion in a case of acute myelogenous leukemia (AML) (1 case) and disseminated infection in two case of neutropenic patient with acute Leukemia (2 cases). The clinical manifestation were characterized by localized involvement, slow pace of progression, lesion of scaly verrucous formation and laceration. Rarely, the infection lead to invasive disease in immunocompromised patients. Mostly, terbinafine, itraconazole and/or amphotericin B were used and showed effective for the treatment.

7 / Cutaneous infection caused by Fusarium lichenicola in a patient with verrucous hyperplasia vermiculatum manifestation