title: Spectral Manifestation of Melanized Fungal Infections in Kidney Transplant Recipients: Report of Six Cases.
abstract: Chromoblastomycosis and phaeohyphomycosis are melanized fungal infections, which affect skin and subcutaneous tissues in immunocompetent and immunosuppressed patients, as solid-organ transplant recipients, respectively. In this present study, we report six cases of melanized fungal infection in kidney transplant recipients. In five cases, culture of tissue specimens identified two cases of Exophiala spp. and three cases of Fonsecaea spp. Molecular identification was performed in three cases based on sequencing of rDNA (ITS region) that revealed the following agents: Exophiala xenobiotica, Exophiala bergeri and Fonsecaea monophora. Clinically, they presented verrucous lesion, erythematous-squamous plaque, nodules and lymphangitic distribution. Histopathological aspect was tuberculous granuloma, with concomitant presence of muriform bodies and hyphae. Some patients presented fungal transepithelial elimination. One patient received only terbinafine. Three patients underwent surgery, and two of them received itraconazole. In these four cases, the infection did not relapse. The other two patients were treated only with itraconazole, one of them is still under treatment and the other one was lost to follow-up. These patients presented clinical and histopathological characteristics ranging from resistant to nonresistant forms.
authors.affiliation: Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil. mariliaogawa@gmail.com.
authors.forename: Marilia M
authors.initials: MM
authors.lastname: Ogawa
authors.affiliation: Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil.
authors.forename: Marcella P
authors.initials: MP
authors.lastname: Peternelli
authors.affiliation: Department of Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Milvia M S S
authors.initials: MM
authors.lastname: Enokihara
authors.affiliation: Special Laboratory of Mycology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Nishikaku
authors.affiliation: Department of Pathology, Federal University of Espírito Santo (UFES), Vitória, Brazil.
authors.forename: Sarah Santos
authors.initials: SS
authors.lastname: Gonçalves
authors.affiliation: Department of Dermatology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 508, São Paulo, SP, CEP 04038-001, Brazil.
authors.forename: Jane
authors.initials: J
authors.lastname: Tomimori
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D017422:Sequence Analysis, DNA; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer
keywords: Chromoblastomycosis; Dematiaceous; Kidney transplantation; Mycosis; Pathology; Phaeohyphomycosis