Spectral Manifestation of Melanized Fungal Infections in Kidney Transplant Recipients: Report of Six Cases

Chromoblastomycosis and phaeohyphomycosis are melanized fungal infections, which affect skin and subcutaneous tissues in immunocompetent and immunosuppressed patients, as solid-organ transplant recipients, respectively. In this present study, we report six cases of melanized fungal infection in kidney transplant recipients. In five cases, culture of tissue specimens identified two cases of Exophiala spp. and three cases of Fonsecaea spp. Molecular identification was performed in three cases based on sequencing of rDNA (ITS region) that revealed the following agents: Exophiala xenobiotica, Exophiala bergeri and Fonsecaea monophora. Clinically, they presented verrucous lesion, erythematous-squamous plaque, nodules and lymphangitic distribution. Histopathological aspect was tuberculous granuloma, with concomitant presence of muriform bodies and hyphae. Some patients presented fungal transepithelial elimination. One patient received only terbinafine. Three patients underwent surgery, and two of them received itraconazole. In these four cases, the infection did not relapse. The other two patients were treated only with itraconazole, one of them is still under treatment and the other one was lost to follow-up. These patients presented clinical and histopathological characteristics ranging from resistant to nonresistant forms.