Dematiaceous Fungal Infections in Hematopoietic Stem Cell Transplantation and Predisposing Hematological Conditions:...

Dematiaceous fungi can cause invasive disease in patients with hematological malignancies and hematopoietic stem cell transplant (HSCT) recipients.

To characterize the spectrum of disease in these populations, we performed a systematic review of PubMed and Scopus databases (searched 16 August 2026) and included reports with individualized data on dematiaceous fungal infections in adult HSCT recipients and patients with predisposing hematological conditions. A four-domain bias assessment was applied to reports, and data were summarized with descriptive statistics.

We identified 74 reports on 88 patients. The median age was 58 years, 61% were male, and 35% (31/88) were HSCT recipients. The most common genus was Exophiala (18/88; 20%). For 30 patients with information available, 25/30 (83%) received antifungal prophylaxis, and 64% (16/25) broke through mold-active prophylaxis. The most common clinical syndrome was mucocutaneous infection (40/88; 45%), followed by pulmonary (12/88; 14%) and sinusitis (11/88; 13%). Systemic antifungal therapy was administered in 92% (81/88) of infections. For 75 patients with information available, 63% were deceased at the time of reporting.

Although limited by biases inherent to case reports, this review identified high all-cause mortality and frequent breakthrough infections. No funding sources were used, and this protocol was not registered.