title: Subcutaneous phaeohyphomycosis in transplant recipients: review of the literature and demonstration of in vitro synergy between antifungal agents.
abstract: Infection of subcutaneous tissue by black fungi (subcutaneous phaeohyphomycosis) has only been reported in six transplant patients, all of whom were solid organ recipients. These patients presented with indolent, localized infections at least 1 year after transplant, while on maintenance immunosuppressive regimens. They were cured by surgical resection, either alone or in conjunction with antifungal agents. We report a case of subcutaneous phaeohyphomycosis occurring in a bone marrow transplant recipient receiving high doses of immunosuppressive agents, in whom widespread subcutaneous infection due to Exophiala jeanselmei was not eradicated by repeated resections and therapy with amphotericin B and flucytosine. The infection was eventually cured after addition of itraconazole to the therapeutic regimen. Results of in vitro testing of the isolate for susceptibility to a combination of amphotericin B, flucytosine and itraconazole confirmed the potential role of combination antifungal therapy in the setting of refractory infection.
authors.affiliation: Department of Medicine, University of Florida College of Medicine, Gainesville 32610, USA. nguyemt@medicine.ufl.edu
authors.forename: C J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
authors.forename: M
authors.initials: M
authors.lastname: Hong Nguyen
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001706:Biopsy; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003881:Dermatomycoses / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005437:Flucytosine / Q000627:therapeutic use; D005658:Fungi / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000382:microbiology / Q000473:pathology
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D005437:Flucytosine