BMJ Case Reports 2018; doi:10.1136/bcr-2017-222527
  • Rare disease

Double invasive fungal infection due to dematiaceous moulds in a renal transplant patient

  1. Marina Nunez1
  1. 1Department of Infectious Diseases, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  2. 2Pathology Labs, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Guy El Helou, gelhelou{at}
  • Accepted 19 January 2018
  • Published 8 February 2018


Alternaria and Verruconis are two dematiaceous moulds that occasionally cause disease in immunocompromised hosts. We present the case of a 58-year-old man with history of deceased donor renal transplantation 14 months prior, who presented with fevers and cough. He was found to have right upper lobe pneumonia and a non-healing eschar of his right knee. Dematiaceous fungi grew from bronchoalveolar lavage (BAL) and was sent to reference lab for identification. Meanwhile, the eschar on his right knee was biopsied and grew Alternaria spp. Pathology was consistent with invasive mould infection and he was treated as having disseminated Alternaria infection with voriconazole and amphotericin B lipid complex. Later on, the dematiaceous mould from a BAL specimen was identified as Verruconis gallopava. The patient was discharged on voriconazole awaiting minimal inhibitory concentrations for V. gallopava but was readmitted 2 days later with high fevers and died from acute respiratory failure.


  • Contributors GEH and MN: took part in caring for and treating patient with the infectious diseases department. EP: is head of the microbiology lab and offered great help in identifying the different molds. All authors: contributed in this manuscript through writing and editing.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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