Phaeohyphomycoses in kidney transplant recipients: A 10-year retrospective study from the French West Indies

Phaeohyphomycoses (PHM), infections caused by pigmented fungi, are increasingly reported in kidney transplant recipients (KTR), but data remains scarce. We retrospectively reviewed all episodes of PHM in KTR at the Guadeloupe University Hospital (French West Indies) from January 1st, 2012, to December 31st, 2022. Eighteen episodes of PHM occurred in 17 KTRs, corresponding to an incidence of 1.56 cases per 100 person-years. Median time from transplantation to PHM onset was 15 months (interquartile range: 9.0-23.5 months). Most episodes were localized cutaneous infections (n = 16/18). Twelve fungal species were identified; Paraconiothyrium cyclothyrioides was the most frequent (n = 6/18, 33%). This fungus it is not yet acknowledged as pathogenic in the current European guidelines. Surgery was performed in 41% of episodes with available data-some data are missing due to the loss of paper files. Eighty-two percent of patients received antifungal therapy (mainly azoles). Overall outcome was favorable in 82%. Three deaths occurred during follow-up; one was directly attributable to disseminated PHM. Diagnosing PHM is not that unusual in this caribbean transplant center, mainly presented as localized skin infections, with a distinctive species distribution characterized by predominance of P. cyclothyrioides and absence of Alternaria spp. With accurate diagnosis, combine surgical/medical therapy and control of transplant organ management, the vast majority of patients can be successfully managed.