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. 2011 Sep 14:5:460.
doi: 10.1186/1752-1947-5-460.

A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report

Umasankar Mathuram Thiyagarajan  1 , Atul Bagul, Michael L Nicholson
Affiliations

A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report

Umasankar Mathuram Thiyagarajan et al. J Med Case Rep. .

Abstract

Introduction: Pyrenochaeta romeroi (P. romeroi) is a saprophytic fungus found in soil and plants. The fungal spores can be introduced into deeper tissues by trauma. It causes eumycetoma, which affects skin and subcutaneous tissues.

Case presentation: A 57-year-old South Asian man presented with a painless, nodular lesion (1 cm × 0.5 cm) on the left knee. He had had a renal transplant eight months earlier for end-stage renal failure. The patient was on tacrolimus, mycophenolate mofetil and prednisolone for immunosuppression. The lesion had progressed dramatically (to 5 cm × 5 cm) despite antibiotic treatment. The size and location of the lesion was severely affecting his quality of life, so an excision biopsy was performed. Nuclear ribosomal repeat-region sequencing confirmed the causative organism as P. romeroi. An in vitro antifungal susceptibility test demonstrated that P. romeroi was sensitive to voriconazole. Following a successful surgical removal, voriconazole was continued orally for two months.

Conclusion: To the best of our knowledge, we are reporting the first case of Eumycetoma caused by P. romeroi in a renal transplant recipient. Physicians should be aware of this rare fungal disease in transplant recipients. We recommend a combination of medical and surgical management in these immunosuppressed patients.

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Figures

Figure 1
Figure 1
Cystic lesion on the left knee.
Figure 2
Figure 2
PAS positive branching and septate hyphae on histology.
See this image and copyright information in PMC

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References

    1. Evans EGV. Pathogenesis, Immunity, Laboratory Diagnosis and Control. 16. London: Churchill Livingstone; 2002. Fungi: thrush, ringworm, subcutaneous and systemic mycoses. A Guide to Microbial Infections; pp. 568–588.
    1. Badali H, Chander J, Gulati N, Attri A, Chopra R, Najafzadeh MJ, Chhabra S, Meiss JF, De Hoog GS. Subcutaneous phaeohyphomycotic cyst caused by Pyrenochaeta romeroi. Med Mycol. 2010;48:763–768. doi: 10.3109/13693780903440383. - DOI - PubMed
    1. Girard C, Dereure O, Rispail P, Durand L, Guilhou JJ. Subcutaneous phaeohyphomycosis due to Pyrenochaeta romeroi in a patient with leprosy. Acta Derma Venereol. 2004;84:154–155. doi: 10.1080/00015550310006824. - DOI - PubMed
    1. Cerar D, Malallah YM, Howard SJ, Bowyer P, Denning DW. Isolation, identification and susceptibility of Pyrenochaeta romeroi in a case of eumycetoma of the foot in the UK. Int J Antimicrob Agents. 2009;34:605–616. doi: 10.1016/j.ijantimicag.2009.07.003. - DOI - PubMed
    1. Khan Z, Ahmad S, Kapila K, Ramaswamy N, Alath P, Joseph L, Chandy R. Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst. J Med Microbiol. 2011;60:842–846. doi: 10.1099/jmm.0.029520-0. - DOI - PubMed

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