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

BMJ Case Rep. 2018 Feb 8:2018:bcr2017222527. doi: 10.1136/bcr-2017-222527.

Abstract

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.

Keywords: infections; malignant disease and immunosuppression; pneumonia (infectious disease); renal transplantation.

Publication types

  • Case Reports

MeSH terms

  • Alternaria / isolation & purification
  • Alternariosis / diagnosis
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Ascomycota / isolation & purification*
  • Fatal Outcome
  • Humans
  • Immunocompromised Host*
  • Invasive Fungal Infections / diagnosis*
  • Invasive Fungal Infections / drug therapy
  • Invasive Fungal Infections / pathology
  • Kidney Transplantation* / adverse effects
  • Knee / microbiology
  • Lung Diseases, Fungal / diagnosis*
  • Lung Diseases, Fungal / drug therapy
  • Lung Diseases, Fungal / pathology
  • Male
  • Middle Aged
  • Pneumonia / diagnostic imaging
  • Pneumonia / drug therapy
  • Risk Factors
  • Voriconazole / therapeutic use

Substances

  • Antifungal Agents
  • liposomal amphotericin B
  • Amphotericin B
  • Voriconazole