doi: 10.1111/1346-8138.12719
Journal of Dermatology 2015; 42: 263–266
CONCISE COMMUNICATION
Case of cutaneous phaeohyphomycosis caused by Phaeoacremonium sp. in a renal transplant recipient Yuichi SAKATA,1 Asuka KITAYAMA,1 Rieko YOSHIMURA,1 Kazushi ANZAWA,1,2 Toshiki FUJII,1 Keiji FUJIMOTO,3 Hitoshi YOKOYAMA,3 Takashi MOCHIZUKI1,2 1
Department of Dermatology, 2Division of Dermatomycology, Research Institute of Medical Science, and 3Department of Nephrology, Kanazawa Medical University, Uchinada, Japan
ABSTRACT We describe a case of cutaneous phaeohyphomycosis in a 61-year-old man receiving re-dialysis treatment for renal failure of a transplanted kidney. He was immunocompromised with steroid and cyclosporin A at onset of an asymptomatic abscess on his right forearm. The abscess arose at the site of a skin injury approximately 1 year prior. Grayish molds isolated from the lesion were morphologically compatible with Phaeoacremonium sp. but nucleotide sequence data of internal transcribed spacer regions of ribosomal RNA gene, actin and b-tubulin genes were unlike those of any described species. He was successfully treated with a total of 3 weeks of liposomal amphotericin B, but died of pneumonia approximately 3 months after cure of phaeohyphomycosis.
Key words:
abscess, cutaneous infection, Phaeoacremonium, phaeohyphomycosis, renal transplant recipient.
INTRODUCTION Dematiaceous fungal skin infections are classified into three types: (i) chromoblastomycosis; (ii) phaeohyphomycosis (PHM); and (iii) eumycotic mycetoma. The incidence of PHM characterized by presence of hyphae or yeast-like cells or both without any muriform body in tissue1,2 has increased recently. PHM is now recognized as an important opportunistic infection. We report a case of PHM caused by Phaeoacremonium sp., ubiquitous in nature, but an uncommon pathogen in skin infection.
CASE REPORT The 61-year-old patient had been treated for chronic renal failure and began hemodialysis at age 36 years, with kidney transplant at 48 years. He had diabetes and arteriosclerosis, and underwent below the knee amputation of his right leg at 56 years due to gangrene of the foot. At age 61-years-old, re-dialysis treatment was started because of rapidly progressing renal failure of the transplanted kidney. He was administrated 2 mg/day of methylprednisolone sodium succinate and 80 mg/day of cyclosporin A. An abscess was noticed on the extensor surface of his right forearm and he was referred to our clinic. He complained of slight tenderness on the nodules but no spontaneous pain. He recalled that the lesion arose at the site of a skin injury in his backyard approximately 1 year previously. The lesion comprised a coalescence of erythematous nodules on an infiltrated plaque of approximately 3 cm in diameter (Fig. 1a). Some soft nodules were discharging yellowish pus
spontaneously. Laboratory findings included: red blood cell count, 3.00 9 106/mL; white blood cell count, 8520/mL; neutrophils, 85.7%; C-reactive protein, 0.95 ng/mL; glucose, 202 mg/dL; albumin, 1.9 g/dL; and b-D-glucan, less than 6 pg/ mL (normal,
Journal of Dermatology 2015; 42: 263–266
CONCISE COMMUNICATION
Case of cutaneous phaeohyphomycosis caused by Phaeoacremonium sp. in a renal transplant recipient Yuichi SAKATA,1 Asuka KITAYAMA,1 Rieko YOSHIMURA,1 Kazushi ANZAWA,1,2 Toshiki FUJII,1 Keiji FUJIMOTO,3 Hitoshi YOKOYAMA,3 Takashi MOCHIZUKI1,2 1
Department of Dermatology, 2Division of Dermatomycology, Research Institute of Medical Science, and 3Department of Nephrology, Kanazawa Medical University, Uchinada, Japan
ABSTRACT We describe a case of cutaneous phaeohyphomycosis in a 61-year-old man receiving re-dialysis treatment for renal failure of a transplanted kidney. He was immunocompromised with steroid and cyclosporin A at onset of an asymptomatic abscess on his right forearm. The abscess arose at the site of a skin injury approximately 1 year prior. Grayish molds isolated from the lesion were morphologically compatible with Phaeoacremonium sp. but nucleotide sequence data of internal transcribed spacer regions of ribosomal RNA gene, actin and b-tubulin genes were unlike those of any described species. He was successfully treated with a total of 3 weeks of liposomal amphotericin B, but died of pneumonia approximately 3 months after cure of phaeohyphomycosis.
Key words:
abscess, cutaneous infection, Phaeoacremonium, phaeohyphomycosis, renal transplant recipient.
INTRODUCTION Dematiaceous fungal skin infections are classified into three types: (i) chromoblastomycosis; (ii) phaeohyphomycosis (PHM); and (iii) eumycotic mycetoma. The incidence of PHM characterized by presence of hyphae or yeast-like cells or both without any muriform body in tissue1,2 has increased recently. PHM is now recognized as an important opportunistic infection. We report a case of PHM caused by Phaeoacremonium sp., ubiquitous in nature, but an uncommon pathogen in skin infection.
CASE REPORT The 61-year-old patient had been treated for chronic renal failure and began hemodialysis at age 36 years, with kidney transplant at 48 years. He had diabetes and arteriosclerosis, and underwent below the knee amputation of his right leg at 56 years due to gangrene of the foot. At age 61-years-old, re-dialysis treatment was started because of rapidly progressing renal failure of the transplanted kidney. He was administrated 2 mg/day of methylprednisolone sodium succinate and 80 mg/day of cyclosporin A. An abscess was noticed on the extensor surface of his right forearm and he was referred to our clinic. He complained of slight tenderness on the nodules but no spontaneous pain. He recalled that the lesion arose at the site of a skin injury in his backyard approximately 1 year previously. The lesion comprised a coalescence of erythematous nodules on an infiltrated plaque of approximately 3 cm in diameter (Fig. 1a). Some soft nodules were discharging yellowish pus
spontaneously. Laboratory findings included: red blood cell count, 3.00 9 106/mL; white blood cell count, 8520/mL; neutrophils, 85.7%; C-reactive protein, 0.95 ng/mL; glucose, 202 mg/dL; albumin, 1.9 g/dL; and b-D-glucan, less than 6 pg/ mL (normal,
