title: Hyalohyphomycosis caused by Paecilomyces lilacinus after kidney transplantation.
abstract: Hyalohyphomycosis caused by Paecilomyces has rarely been described among solid organ recipients. Its management is elusive without an established consensus concerning antifungal therapy. Herein we have reported a case of extensive cellulitis caused by Paecilomyces lilacinus observed in a 48-year-old kidney transplanted woman with hepatitis C. Kidney transplantation from a cadaveric donor was performed in October 2006 with an uneventful early course except for posttransplant diabetes mellitus and a reversible acute rejection episode. Cutaneous nodular and verrucous lesions of the left leg appeared in August 2007. In a few weeks, these lesions become ulcerated, hemorrhagic, and painful. The diagnosis was made on the basis of microbiologic culture and histological examination. There was no improvement in the skin lesions after 6 weeks treatment with itraconazole, but voriconazole yielded a good response within the first 2 weeks. There was a good tolerance to antifungal therapy; graft function and liver tests remained normal. We concluded that an increasing emerging of fungal infections is observed with the introduction of more powerful immunosuppressive drugs. Diagnosis and management of such infections is elusive. Preventive measures should be considered including the adaptation of immunosuppressive therapy among at-risk patients especially those with hepatitis C virus infection and diabetics.
authors.affiliation: Department of Internal Medicine A and Laboratory of Kidney Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia. mejid66@yahoo.fr
authors.forename: M
authors.initials: M
authors.lastname: Ounissi
authors.forename: E
authors.initials: E
authors.lastname: Abderrahim
authors.forename: S
authors.initials: S
authors.lastname: Trabelsi
authors.forename: S
authors.initials: S
authors.lastname: Khaled
authors.forename: H
authors.initials: H
authors.lastname: Bezzine
authors.forename: F
authors.initials: F
authors.lastname: Ben Hamida
authors.forename: H
authors.initials: H
authors.lastname: Hedri
authors.forename: T
authors.initials: T
authors.lastname: Ben Abdallah
authors.forename: H
authors.initials: H
authors.lastname: Ben Maïz
authors.forename: A
authors.initials: A
authors.lastname: Kheder
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007372:Interferons / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy; D010143:Paecilomyces; D007690:Polycystic Kidney Diseases / Q000601:surgery / Q000628:therapy; D011183:Postoperative Complications / Q000382:microbiology; D011743:Pyrimidines / Q000627:therapeutic use*; D017582:Renal Replacement Therapy / Q000009:adverse effects; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011743:Pyrimidines; D014230:Triazoles; D012254:Ribavirin; D007372:Interferons; D065819:Voriconazole