title: A deeply invasive Phoma species infection in a renal transplant recipient.
abstract: Phoma sp, a fungus routinely isolated from the soil and a known plant pathogen, was found to be the cause of an aggressive, deep compartment hand infection in a renal transplant recipient. Previous reports have described minimally invasive Phoma sp infections with isolates recovered from the skin or subcutaneous tissue. This case, however, is the first reported in which Phoma sp was found to be both aggressive and deeply invasive. Histologic sections obtained from the synovium of the fourth and fifth dorsal hand compartments revealed invasive hyphal elements. Detailed examination with Grocott-Gomori methenamine-silver staining revealed branching filaments and pycnidia. A Phoma sp was isolated from culture after 2 weeks of incubation. Antifungal agent sensitivity testing found the organism to be sensitive to amphotericin B but resistant to both fluconazole and 5-flucytosine. Treatment required surgical debridement and the use of prolonged systemic amphotericin B therapy in order to effect cure. This is a unique case of a deeply invasive Phoma sp infection, indicating that such processes are not strictly indolent as previously reported.
authors.affiliation: Department of Surgery, University of Iowa, Iowa City, Iowa 52242, USA. jeffrey-evertt@uiowa.edu
authors.forename: J E
authors.initials: JE
authors.lastname: Everett
authors.forename: N P
authors.initials: NP
authors.lastname: Busick
authors.forename: T
authors.initials: T
authors.lastname: Sielaff
authors.forename: D C
authors.initials: DC
authors.lastname: Wahoff
authors.forename: D L
authors.initials: DL
authors.lastname: Dunn
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy; D011183:Postoperative Complications / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole