Bridget E Shields, Misha Rosenbach, Zoe Brown-Joel, Anthony P Berger, Bradley A Ford, Karolyn A Wanat

Angioinvasive fungal infections cause significant morbidity and mortality due to their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, acquired immunodeficiency syndrome (AIDS), organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an "arms race" of emerging fungal resistance patterns. As the at-risk population expands and as new anti-fungal resistance patterns develop, it is critical for dermatologists to understand and recognize angioinvasive fungal pathogens, as they are often the first to encounter the cutaneous manifestations of these diseases. Rapid clinical recognition, histopathologic, and culture confirmation can help render a timely, accurate diagnosis to ensure immediate medical and surgical intervention. As superficial dermatophyte infections and deep fungal infections such as blastomycosis and histoplasmosis have been well characterized within the dermatologic literature, this article will focus on the severe infections acquired by angioinvasive fungal species, including an update on new and emerging pathogens. In part 1 of this series, we review the epidemiology and cutaneous manifestations, and part 2 will focus on diagnosis, treatment, and complications of these infections.