Phaeohyphomycosis in Kidney Transplant Recipients: Highlighting the Importance of Early Recognition and Surgical Debridement

Animesh A Singla; Priya Garg; Juanita N Chui; David Pham; Zachary J Webb-Harvey; Catriona L Halliday; Ramesh De Silva; Ahmer Hameed; Rowan Klein Nulend; Taina Lee; Germaine Wong; Henry Pleass

doi:10.1097/TXD.0000000000001430

Phaeohyphomycosis in Kidney Transplant Recipients: Highlighting the Importance of Early Recognition and Surgical Debridement

Transplant Direct. 2022 Dec 12;9(1):e1430. doi: 10.1097/TXD.0000000000001430. eCollection 2023 Jan.

Authors

Animesh A Singla^{1

2}, Priya Garg³, Juanita N Chui², David Pham⁴, Zachary J Webb-Harvey³, Catriona L Halliday⁴, Ramesh De Silva¹, Ahmer Hameed¹, Rowan Klein Nulend¹, Taina Lee¹, Germaine Wong^{1

5}, Henry Pleass^{1

2}

Affiliations

¹ Transplant Surgery Department, Westmead Hospital, NSW, Australia.
² Faculty of Medicine, Sydney University, NSW, Australia.
³ Center for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia.
⁴ Center for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.
⁵ Renal Department, Westmead Hospital, Westmead, NSW, Australia.

Abstract

Fungal infections are a recognized complication of immunosuppression in solid organ transplant recipients. Phaeohyphomycoses are fungal infections caused by a diverse group of dematiaceous fungi.

Methods: We share the learning points from 2 Australian cases of phaeohyphomycosis secondary to Phaeacreomonium species (spp). A literature review was performed using Medline, Embase, and Google Scholar to identify this condition among kidney transplant recipients.

Results: With the 2 cases reported in this article, a total of 17 cases were identified in the literature. Phaeacremonium spp is ubiquitous in humid and temperate flora, including Australia. Minor trauma is likely the source of inoculation in most cases and diagnosis is often delayed. Presently, no guidelines for management exist given the rarity of this condition. Most known cases have been treated with surgical debulking combined with long-course antifungal therapy.

Conclusion: This paper describes 2 Australian cases of phaeohyphomycosis in kidney transplant recipients. A high index of suspicion, especially in the immunosuppressed, is essential for timely diagnosis in kidney transplant recipients. There are several diagnostic and therapeutic challenges that remain with this condition.