title: Surgical resection of a rare cutaneous manifestation of Scedosporium apiospermum in a patient who underwent renal transplant.
abstract: A man aged 47 years who was immunosuppressed following renal transplantation for focal segmental glomerulosclerosis was referred to the Plastic Surgery team for management of a painful, chronic, granulomatous lesion of the right forearm. Serial ultrasound scans and MRI scans were not diagnostic, but microbiological specimens tested positive for the fungus Scedosporium apiospermum The renal transplant graft-which was failing-was removed, allowing him to cease immunosuppression. He then underwent a resection of the lesion and reconstruction with a split thickness skin graft. Analysis of the specimen revealed fibrosis, granulomatosis and a collection of S. apiospermum He was started on voriconazole which, in conjunction with his surgical resection, appears to have kept the disease at bay. With increasing numbers of solid organ transplants and improved survival, this case highlights the growing burden of rare, opportunistic infections, the difficulty in diagnosis and the need for specialist intervention.
authors.affiliation: Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK.
authors.forename: A C S
authors.initials: AC
authors.lastname: Stoneham
authors.affiliation: Department of Dermatology, St Mary's Hospital, Portsmouth, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Stoneham
authors.affiliation: Department of Microbiology, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Wyllie
authors.affiliation: Department of Plastic Surgery, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Pandya
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D003881:Dermatomycoses / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D021681:Scedosporium; D016038:Skin Transplantation; D014057:Tomography, X-Ray Computed; D065819:Voriconazole / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D065819:Voriconazole