Invasive cutaneous Neoscytalidium infections in renal transplant recipients: a series of five cases

Abstract

Background: Neoscytalidium species (formerly Scytalidium species) are black fungi that usually cause cutaneous infections mimicking dermatophytes lesions. Very few publications have reported invasive or disseminated infections.

Case presentation: In this paper, we report the clinical presentations, treatments and outcomes of five cases of invasive Neoscytalidium infections with cutaneous involvement, including two cases with disseminated infection, in five renal transplant recipients. To our knowledge, this is the first report of a series-albeit small-of renal transplant patients in whom this infection was identified. All cases occurred in a single hospital in Paris, France, between 2001 and 2011. Patients all originate from tropical area.

Conclusion: Treatments of Neoscytalidium infection varied greatly, underlining the lack of a recommendation for a standardized treatment. All patients were cured after long-term antifungal therapy and/or surgical excision. Interestingly, one patient with disseminated infection involving the left elbow, the right leg, the lungs and the nasal septum was cured by medical therapy only without surgery. This may suggest that in contrast to others mycoses (such as mucormycosis), an adequate medical treatment could be sufficient for treating Neoscytalidium. We also point out the difficulties we had in diagnosing two patients with Kaposi's sarcoma because of the similarity of the lesions. Furthermore, our report underlines the need to check for this rare infection in immunocompromised kidney transplant recipients originating from tropical areas.

Fig. 1

Lesion due to Neoscytalidium dimidiatum in a kidney transplant recipient

Fig. 2

Disseminated Neoscytalidium dimidiatum infection in a kidney transplant recipient. Lesion on the left elbow at presentation (2a) and after 2 months of voriconazole therapy (2b). Other localizations included the lungs, sinuses and right leg (2c and 2e). Microscopic examination of the arm lesion showing hyphal fungal elements (2d). Photo of the 72-h culture from the arm lesion showing mold with a black center and white edges