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Review
. 2023 Feb 21;9(3):283.
doi: 10.3390/jof9030283.

Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature

Davide Lo Porto  1 , Andrea Cona  1 , Francesca Todaro  1 , Elena De Carolis  2 , Francesca Cardinale  1 , Neha Hafeez  3 , Giuseppina Di Martino  1 , Pier Giulio Conaldi  1 , Maurizio Sanguinetti  2 , Paolo Antonio Grossi  4 , Alessandra Mularoni  1
Affiliations
Review

Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature

Davide Lo Porto et al. J Fungi (Basel). .

Abstract

Phaeohyphomycosis comprises a variety of infections caused by pigmented fungi. Solid organ transplant (SOT) recipients are particularly at risk of invasive infections due to their prolonged immunosuppression. Here, we describe three cases of phaeohyphomycosis in SOT recipients who were successfully treated with surgical excision and/or antifungal therapy. We additionally carried out a narrative review of the literature on phaeohyphomycosis in 94 SOT recipients from 66 published studies describing 40 different species of fungi. The most reported fungus was Alternaria (21%). The median time from transplant to diagnosis was 18 months (IQR 8.25-48), and kidney transplants were the most reported. Antifungal regimens were not homogeneous, though there was a prevalence of itraconazole- and voriconazole-based treatments. Clinical outcomes included recovery in 81% and death in 5% of infected SOT recipients. Susceptibility testing was done in 26.6% of the cases, with heterogeneous results due to the variety of species isolated. While the wide diversity of dematiaceous fungi and their host range make it difficult to offer a uniform approach for phaeohyphomycosis, an early diagnosis and therapy are critical in preventing the dissemination of disease in the immunocompromised host.

Keywords: Alternaria infectoria; Alternaria alternata; Curvularia hawaiiensis; SOT; itraconazole; phaeohyphomycosis; posaconazole; transplantation; voriconazole.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clinical presentation of cutaneous phaeohyphomycosis. (A) Curvularia hawaiiensis; (B). Alternaria alternata; (C). Alternaria infectoria.
Figure 2
Figure 2
Alternaria alternata culture, the two sides of the plate.
Figure 3
Figure 3
Alternaria alternata microscopy.
See this image and copyright information in PMC

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