Subcutaneous abscess due to Pyrenochaeta romeroi in a renal transplant recipient

Area of Science:

• Medical Mycology
• Dermatology
• Transplant Infectious Diseases

Background:

• Dematiaceous fungi are opportunistic pathogens in immunocompromised individuals, particularly organ transplant recipients.
• Skin lesions in immunocompromised patients warrant consideration of fungal etiology, including rare dematiaceous fungal infections.
• Early recognition and diagnosis are crucial for effective management.

Observation:

• A rare case of a chronic necrotizing granulomatous skin lesion caused by Pyrenochaeta romeroi is presented in a renal transplant recipient.
• This represents the first reported case of Pyrenochaeta romeroi infection in a renal transplant recipient in Singapore.
• The clinical presentation involved a persistent, necrotizing skin lesion.

Findings:

• Pyrenochaeta romeroi, a dematiaceous fungus, was identified as the causative agent of the skin lesion.
• Identification of certain dematiaceous fungi can be challenging, often requiring specialized molecular diagnostic techniques.
• The patient's immunocompromised status post-renal transplantation was a significant predisposing factor.

Implications:

• This case highlights the importance of considering dematiaceous fungal infections in the differential diagnosis of skin lesions in transplant recipients.
• Effective management typically involves a combination of surgical excision and prolonged antifungal therapy.
• Further research is needed to establish optimal antifungal treatment regimens for such rare infections.