Journal of the American Academy of Dermatology
Volume 61, Issue 6 , Pages 977-985 , December 2009

Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients

  • Marília Marufuji Ogawa, MD

      Affiliations

    • Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
    • Drs Ogawa and Galante contributed equally to this work and are both first authors.
    • ,
  • Nelson Zocoler Galante, MD, PhD

      Affiliations

    • Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
    • Drs Ogawa and Galante contributed equally to this work and are both first authors.
    • ,
  • Patrício Godoy, PhD

      Affiliations

    • Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
    • ,
  • Olga Fischman-Gompertz, PhD

      Affiliations

    • Division of Cellular Biology, Federal University of São Paulo, São Paulo, Brazil
    • ,
  • Flavia Martelli, MD

      Affiliations

    • Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
    • ,
  • Arnaldo Lopes Colombo, MD, PhD

      Affiliations

    • Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
    • ,
  • Jane Tomimori, MD, PhD

      Affiliations

    • Department of Dermatology, Federal University of São Paulo, São Paulo, Brazil
    • ,
  • José Osmar Medina-Pestana, MD, PhD

      Affiliations

    • Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
    • Corresponding Author InformationReprint requests: José Osmar Medina-Pestana, MD, PhD, Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 11° andar, Vila Clementino, São Paulo - SP, Brazil. CEP: 04038-002.

,Accepted 3 March 2009.

References 

  1. Rubin R. Infectious disease complications of renal transplantation. Kidney Int. 1993;44:221–236
  2. Virgili A, Zampino M, Mantovani L. Fungal skin infections in organ transplant recipients. Am J Clin Dermatol. 2002;3:19–35
  3. Revankar S, Patterson J, Sutton D, Pullen R, Rinaldi M. Disseminated phaeohyphomycosis: review of an emerging mycosis. Clin Infect Dis. 2002;34:467–476
  4. Revankar S. Dematiaceous fungi. Mycoses. 2007;50:91–101
  5. Medina-Pestana J. Organization of a high-volume kidney transplant program–the “assembly line” approach. Transplantation. 2006;81:1510–1520
  6. Silveira F, Nucci M. Emergence of black moulds in fungal disease: epidemiology and therapy. Curr Opin Infect Dis. 2001;14:679–684
  7. Chen S, Sorrell T. Antifungal agents. Med J Aust. 2007;187:404–409
  8. Pang K, Wu J, Huang D, Tyring S. Subcutaneous fungal infections. Dermatol Ther. 2004;17:523–531
  9. McGinnis M. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol. 1983;8:1–16
  10. Rinaldi M. Phaeohyphomycosis. Dermatol Clin. 1996;14:147–153
  11. Jacobson E. Pathogenic roles for fungal melanins. Clin Microbiol Rev. 2000;13:708–717
  12. Morrison V, Haake R, Weisdorf D. The spectrum of non- Candida fungal infections following bone marrow transplantation. Medicine (Baltimore). 1993;72:78–89
  13. Paya C. Fungal infections in solid-organ transplantation. Clin Infect Dis. 1993;16:677–688
  14. Ajello L, Georg L, Steigbigel R, Wang C. A case of phaeohyphomycosis caused by a new species of Phialophora. Mycologia. 1974;66:490–498
  15. Ruiz-Díez B, Martínez-Suárez J. Isolation, characterization, and antifungal susceptibility of melanin-deficient mutants of Scedosporium prolificans. Curr Microbiol. 2003;46:228–232
  16. Mesa A, Henao J, Gil M, Durango G. Phaeohyphomycosis in kidney transplant patients. Clin Transplant. 1999;13:273–276
  17. Porto E, Lacaz CS, Sabbaga E, Chocair PR, Fonseca JA, Rivitti EA, et al. Phialophora bubakii. Isolamento de abscesso subcutâneo em transplantado renal. Rev Inst Med Trop Sao Paulo. 1979;21:106–109
  18. Sindhuphak W, MacDonald E, Head E, Hudson R. Exophiala jeanselmei infection in a postrenal transplant patient. J Am Acad Dermatol. 1985;13:877–881
  19. Cucé LC, Salebian A, Porto E, Melo NT, Lacaz CS. Feohifomicose em transplantada renal por Exophiala dermatitidis (Kano) de Hoog 1977. An Bras Dermatol. 1986;61:207–211
  20. Porto E, Cucé LC, Lacaz CS, Salebian A, Morais MM. Feo-hifomiose por Cladosporium bantianum (Xylohypha bantiana). Registro de um caso em transplantada renal. An Bras Dermatol. 1987;62:173–179
  21. Hachisuka H, Matsumoto T, Kusuhara M, Nomura H, Nakano S, Sasai Y. Cutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation. Int J Dermatol. 1990;29:198–200
  22. Sabbaga E, Tedesco-Marchesi LM, Lacaz CS, Cucé LC, Salebian A, Heins-Vaccari EM, et al. Feo-hifomicose subcutânea por Exophiala jeanselmei. Registro de três casos em transplantados renais. Rev Inst Med Trop Sao Paulo. 1994;36:175–183
  23. Gold WL, Vellend H, Salit IE, Campbell I, Summerbell R, Rinaldi M, et al. Successful treatment of systemic and local infections due to Exophiala species. Clin Infect Dis. 1994;19:339–341
  24. Jha V, Krishna VS, Chakrabarti A, Sharma PK, Sud K, Kohli HS, et al. Subcutaneous phaeohyphomycosis in a renal transplant recipient: a case report and review of the literature. Am J Kidney Dis. 1996;28:137–139
  25. Franco A, Aranda I, Fernandez MJ, Arroyo MA, Navas F, Albero D, et al. Chromomycosis in a European renal transplant recipient. Nephrol Dial Transplant. 1996;11:715–716
  26. McCown H, Sahn E. Subcutaneous phaeohyphomycosis and nocardiosis in a kidney transplant patient. J Am Acad Dermatol. 1997;36:863–866
  27. Romano C, Valenti L, Miracco C, Alessandrini C, Paccagnini E, Faggi E, et al. Two cases of cutaneous phaeohyphomycosis by Alternaria alternata and Alternaria tenuissima. Mycopathologia. 1997;137:65–74
  28. Acland K, Hay R, Groves R. Cutaneous infection with Alternaria alternata complicating immunosuppression: successful treatment with itraconazole. Br J Dermatol. 1998;138:354–356
  29. Sartoris K, Baillie G, Tiernan R, Rajagopalan P. Phaeohyphomycosis from Exophiala jeanselmei with concomitant Nocardia asteroides infection in a renal transplant recipient: case report and review of the literature. Pharmacotherapy. 1999;19:995–1001
  30. Altomare G, Capella G, Boneschi V, Viviani M. Effectiveness of terbinafine in cutaneous alternariosis. Br J Dermatol. 2000;142:840–841
  31. Castro LG, da Silva Lacaz C, Guarro J, Gené J, Heins-Vaccari EM, de Freitas Leite RS, et al. Phaeohyphomycotic cyst caused by Colletotrichum crassipes. J Clin Microbiol. 2001;39:2321–2324
  32. Halaby T, Boots H, Vermeulen A, van der Ven A, Beguin H, van Hooff H, et al. Phaeohyphomycosis caused by Alternaria infectoria in a renal transplant recipient. J Clin Microbiol. 2001;39:1952–1955
  33. Mathew R, Abraham G, Kalyani J. Late onset phaeomycotic cyst in a renal transplant recipient. Int J Dermatol. 2002;41:898–900
  34. Mayser P, Nilles M, de Hoog G. Case report: cutaneous phaeohyphomycosis due to Alternaria alternata. Mycoses. 2002;45:338–340
  35. Yehia M, Thomas M, Pilmore H, Van Der Merwe W, Dittmer I. Subcutaneous black fungus (phaeohyphomycosis) infection in renal transplant recipients: three cases. Transplantation. 2004;77:140–142
  36. de Monbrison F, Piens M, Ample B, Euvrard S, Cochat P, Picot S. Two cases of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei, in cardiac transplant and renal transplant patients. Br J Dermatol. 2004;150:597–598
  37. Dutriaux C, Saint-Cyr I, Desbois N, Calès-Quist D, Diedhou A, Boisseau-Garsaud A. Subcutaneous phaeohyphomycosis due to Exophiala spinifera in a renal transplant recipient. Ann Dermatol Venereol. 2005;132:259–262
  38. Romano C, Vanzi L, Massi D, Difonzo E. Subcutaneous alternariosis. Mycoses. 2005;48:408–412
  39. Marques SA, Camargo RM, Summerbell RC, De Hoog GS, Ishioka P, Chambô-Cordaro LM, et al. Subcutaneous phaeohyphomycosis caused by Phaeoacremonium parasiticum in a renal transplant patient. Med Mycol. 2006;44:671–676
  40. González-López M, Salesa R, González-Vela M, Fernández-Llaca H, Val-Bernal J, Cano J. Subcutaneous phaeohyphomycosis caused by Exophiala oligosperma in a renal transplant recipient. Br J Dermatol. 2007;156:762–764
  41. Sheikh S, Amr S. Mycotic cysts: report of 21 cases including eight pheomycotic cysts from Saudi Arabia. Int J Dermatol. 2007;46:388–392
  42. Farina C, Gotti E, Parma A, Naldi L, Goglio A. Pheohyphomycotic soft tissue disease caused by Alternaria alternata in a kidney transplant patient: a case report and literature review. Transplant Proc. 2007;39:1655–1659
  43. Sutton D, Slifkin M, Yakulis R, Rinaldi M. US. case report of cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (R. mackenziei): criteria for identification, therapy, and review of other known dematiaceous neurotropic taxa. J Clin Microbiol. 1998;36:708–715
  44. Cunha-Filho RR, Schwartz J, Rehn M, Vettorato G, Resende MA. Feohifomicose causada por Veronaea bothryosa: relato de dois casos. An Bras Dermatol. 2005;80:53–56
  45. Singh N, Heitman J. Antifungal attributes of immunosuppressive agents: new paradigms in management and elucidating the pathophysiologic basis of opportunistic mycoses in organ transplant recipients. Transplantation. 2004;77:795–800
  46. Husain S, Wagener M, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis. 2001;7:375–381
  47. Singh N, Alexander BD, Lortholary O, Dromer F, Gupta KL, John GT, et al. Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality. J Infect Dis. 2007;195:756–764
  48. Sharkey PK, Graybill JR, Rinaldi MG, Stevens DA, Tucker RM, Peterie JD, et al. Itraconazole treatment of phaeohyphomycosis. J Am Acad Dermatol. 1990;23:577–586
  49. Sudduth EJ, Crumbley AJ, Farrar WE. Phaeohyphomycosis due to Exophiala species: clinical spectrum of disease in humans. Clin Infect Dis. 1992;15:639–644
  50. Pickles RW, Pacey DE, Muir DB, Merrell WH. Experience with infection by Scedosporium prolificans including apparent cure with fluconazole therapy. J Infect. 1996;33:193–197
  51. South DA, Brass C, Stevens DA. Chromohyphomycosis treatment with ketoconazole. Arch Dermatol. 1981;117:311–312

 Funding sources: None.

 Conflicts of interest: None declared.

PII: S0190-9622(09)00379-X

doi: 10.1016/j.jaad.2009.03.037

Journal of the American Academy of Dermatology
Volume 61, Issue 6 , Pages 977-985 , December 2009

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