title: Dual Invasive Infection with Phaeoacremonium parasiticum and Paraconiothyrium cyclothyrioides in a Renal Transplant Recipient: Case Report and Comprehensive Review of the Literature of Phaeoacremonium Phaeohyphomycosis.
abstract: Despite increasing reports of human infection, data about the optimal care of Phaeoacremonium infections are missing. We report a case of an infection due to Phaeoacremonium parasiticum and Paraconiothyrium cyclothyrioides, initially localized to skin and soft tissue, in a kidney transplant patient. Despite surgical drainage and excision of the lesion and combination antifungal therapy with voriconazole and liposomal amphotericin B, a disseminated infection involving the lungs and brain developed and led to death. We performed a systematic literature review to assess the general features and outcome of human infections due to Phaeoacremonium species. Thirty-six articles were selected, and 42 patients, including ours, were reviewed. Thirty-one patients (74%) were immunocompromised because of organ or bone marrow transplantation (n = 17), diabetes or glucose intolerance (n = 10), rheumatoid arthritis or Still's disease (n = 4), chronic hematological diseases (n = 3), or chronic granulomatous disease (n = 3). Ten patients (24%) reported initial cutaneous trauma. Skin and soft tissue infections represented 57% of infections (n = 24), and disseminated infections, all occurring in immunocompromised patients, represented 14% of infections (n = 6). The main antifungal drugs used were azoles (n = 41) and amphotericin B (n = 16). Surgical excision or drainage was performed in 64% of cases (n = 27). The cure rate was 67% (n = 28). There were 10% cases of treatment failure or partial response (n = 4), 19% relapses (n = 8), and 7% losses to follow-up (n = 3). The death rate was 19% (n = 8). Management of Phaeoacremonium infections is complex because of slow laboratory identification and limited clinical data, and treatment relies on a combination of surgery and systemic antifungal therapy.
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Marie-Alice
authors.initials: MA
authors.lastname: Colombier
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France Unité de Mycologie Moléculaire et Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Laboratoire de Mycologie, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Alanio
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Denis
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Melica
authors.affiliation: Unité de Mycologie Moléculaire et Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
authors.forename: Dea
authors.initials: D
authors.lastname: Garcia-Hermoso
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France Service de Néphrologie et Transplantation Rénale, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Levy
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France Service de Néphrologie et Transplantation Rénale, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Peraldi
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France Service de Néphrologie et Transplantation Rénale, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Glotz
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité, Paris, France Unité de Mycologie Moléculaire et Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Laboratoire de Mycologie, Hôpital Saint Louis-APHP, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Saint Louis-APHP, Paris, France Université Paris Diderot, Sorbonne Paris Cité, Paris, France sebastien.gallien@sls.aphp.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gallien
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000145:classification / Q000302:isolation & purification*; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D003646:Debridement; D004322:Drainage; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D066027:Transplant Recipients
chemical_list: D000935:Antifungal Agents