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Published on: July 19, 2019
Medicopsis romeroi nodular subcutaneous infection in a kidney transplant recipient
Fakhri Jeddi1, Charlotte Paugam2, Sophie Hartuis3
1Laboratoire de Parasitologie et Mycologie Médicale, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155 - IICiMed, Institut de Recherche en Santé 2, Nantes, France.
Abstract:
Phaeohyphomycosis is a set of fungal infections caused by various dematiaceous fungi such as coelomycetes. These infections can occur either in immunocompetent or immunocompromised patients like solid organ transplants. Here we describe a nodular lesion of the right hallux that occurred in a kidney transplant patient. Microscopic examination of the biopsy revealed fungal hyphae and culture was positive to a grey to black mould that lacked characteristic elements to be identified. Nucleic acid sequencing targeting the internal transcribed spacer of the ribosomal DNA identified this mould as Medicopsis romeroi. The patient benefited of an antifungal therapy with voriconazole associated with surgical excision of the lesion. No relapse of the lesion was observed during a six-month follow-up. In solid organ transplants, phaeohyphomycosis caused by Medicopsis romeroi are very rare with only 12 cases reported. The clinical history should be well assessed since the lesion can appear several years after a cutaneous trauma that happened in a tropical region. Therapy generally combines antifungals with surgical excision of the lesion in order to avoid any relapse or dissemination of the infection.
Insights
A rare fungal infection, phaeohyphomycosis, caused by Medicopsis romeroi was identified in a kidney transplant patient. Successful treatment involved antifungal therapy and surgical excision, preventing relapse.
Area of Science:
- Mycology
- Infectious Diseases
- Transplant Surgery
Background:
- Phaeohyphomycosis comprises fungal infections by dematiaceous fungi.
- These infections affect both immunocompetent and immunocompromised individuals, including solid organ transplant recipients.
- Cutaneous trauma in tropical regions can precede infection development.
Purpose of the Study:
- To report a rare case of phaeohyphomycosis caused by Medicopsis romeroi in a kidney transplant patient.
- To highlight the diagnostic challenges and successful management of this infection.
- To emphasize the importance of clinical history in diagnosing phaeohyphomycosis in transplant recipients.
Main Methods:
- A nodular lesion on the hallux of a kidney transplant patient was biopsied.
- Microscopic examination revealed fungal hyphae.
- Nucleic acid sequencing of the internal transcribed spacer ribosomal DNA identified the causative agent as Medicopsis romeroi.
Main Results:
- The fungal isolate was identified as Medicopsis romeroi.
- The patient received antifungal therapy with voriconazole and underwent surgical excision of the lesion.
- No relapse was observed during a six-month follow-up period.
Conclusions:
- Phaeohyphomycosis caused by Medicopsis romeroi is exceptionally rare in solid organ transplant recipients, with only 12 cases reported.
- Combined antifungal therapy and surgical excision are effective in treating phaeohyphomycosis and preventing recurrence.
- Thorough clinical assessment, including a history of tropical cutaneous trauma, is crucial for diagnosis.
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