Long-Term Carriage of Medicopsis romeroi, an Agent of Black-Grain Mycetoma, Presenting as Phaeohyphomycosis in a Renal Transplant Patient

  • Joshua A. Lieberman
  • Joseph Fiorito
  • Doug Ichikawa
  • Ferric C. Fang
  • Robert M. Rakita
  • Lori BourassaEmail author
Case Report


Medicopsis species are rare fungal pathogens that frequently resist common antifungal therapies and are difficult to identify morphologically as conidia are produced in pycnidia, a key feature of coelomycetes. Immunocompromised patients are at risk of these infections, even after remote exposure, and typically present with phaeohyphomycoses without dissemination. We present the case of a renal transplant recipient 6.5 years post-transplant who developed a slowly progressive soft tissue infection mimicking a synovial cyst. A cultured isolate was identified as Medicopsis romeroi by sequencing of multiple ribosomal loci. The patient responded well to debridement and posaconazole therapy. Solid-organ transplant patients are at risk of opportunistic fungal infection long after transplant, and molecular methods are often required for definitive identification.


Coelomycete Phaeohyphomycosis Medicopsis Solid-organ transplant Mycetoma Dematiaceous 



We thank the Microbiology and Molecular Microbiology Laboratories at the University of Washington Medical Center and Harborview Medical Center, Department of Laboratory Medicine, for performing fungal culture, sequencing, and bioinformatic analysis in the clinical identification of the pathogen. We thank the Department of Podiatry for their role in the clinical care of this patient. We also thank the Fungal Testing Laboratory at the University of Texas at San Antonio for performing sensitivities as part of the patient’s care.

Compliance with Ethical Standards

Conflict of interest

The authors declared that they have no conflicts of interest.

Ethical Approval

This case report was prepared in compliance with the policies of the Institutional Review Board of the University of Washington Medical Center.


  1. 1.
    Wijayawardene NN, Hyde KD, Wanasinghe DN, Papizadeh M, Goonasekara ID, Camporesi E, et al. Taxonomy and phylogeny of dematiaceous coelomycetes. Fungal Divers. 2016;77:1–316.CrossRefGoogle Scholar
  2. 2.
    Sutton DA. Coelomycetous fungi in human disease. A review: clinical entities, pathogenesis, identification and therapy. Rev Iberoam Micol. 1999;16:171–9.Google Scholar
  3. 3.
    Ahmed SA, van de Sande WWJ, Stevens DA, Fahal A, van Diepeningen AD, Menken SBJ, et al. Revision of agents of black-grain eumycetoma in the order Pleosporales. Persoonia. 2014;33:141–54.CrossRefGoogle Scholar
  4. 4.
    Valenzuela-Lopez N, Sutton DA, Cano-Lira JF, Paredes K, Wiederhold N, Guarro J, et al. Coelomycetous fungi in the clinical setting: morphological convergence and cryptic diversity. J Clin Microbiol. 2017;55:552–67.CrossRefGoogle Scholar
  5. 5.
    Ahmed SA, de Hoog GS, Stevens DA, Fahal AH, van de Sande WWJ. In vitro antifungal susceptibility of coelomycete agents of black grain eumycetoma to eight antifungals. Med Mycol. 2015;53:295–301.CrossRefGoogle Scholar
  6. 6.
    Ahmed AAO, van de Sande WWJ, Fahal A, Bakker-Woudenberg I, Verbrugh H, van Belkum A. Management of mycetoma: major challenge in tropical mycoses with limited international recognition. Curr Opin Infect Dis. 2007;20:146–51.CrossRefGoogle Scholar
  7. 7.
    Kulkarni M, Jamale T, Hase N, Ubale M, Keskar V, Jagadish PK. Subcutaneous phaeohyphomycosis caused by pyrenochaeta romeroi in a kidney transplant recipient: a case report. Exp Clin Transpl Off J Middle East Soc Organ Transpl. 2017;15:226–7.Google Scholar
  8. 8.
    Los-Arcos I, Royuela M, Martín-Gómez MT, Alastruey-Izquierdo A, Sellarès J, Perelló M, et al. Phaeohyphomycosis caused by Medicopsis romeroi in solid organ transplant recipients: report of two cases and comprehensive review of the literature. Transpl Infect Dis Off J Transpl Soc. 2019;21(3):e13072.CrossRefGoogle Scholar
  9. 9.
    Rakita RM, O’Brien KD, Bourassa L. Diaporthe soft tissue infection in a heart transplant patient. Transpl Infect Dis Off J Transpl Soc. 2017;19(3):e12680.CrossRefGoogle Scholar
  10. 10.
    Guégan S, Garcia-Hermoso D, Sitbon K, Ahmed S, Moguelet P, Dromer F, et al. Ten-year experience of cutaneous and/or subcutaneous infections due to coelomycetes in France. Open Forum Infect Dis. 2016;3(2):ofw106.CrossRefGoogle Scholar
  11. 11.
    Sharma S, Capoor MR, Singh M, Kiran D, Mandal AK. Subcutaneous phaeohyphomycosis caused by pyrenochaeta romeroi in a rheumatoid arthritis patient: a case report with review of the literature. Mycopathologia. 2016;181:735–43.CrossRefGoogle Scholar
  12. 12.
    Abdolrasouli A, Gonzalo X, Jatan A, McArthur GJ, Francis N, Azadian BS, et al. Subcutaneous phaeohyphomycosis cyst associated with medicopsis romeroi in an immunocompromised host. Mycopathologia. 2016;181:717–21.CrossRefGoogle Scholar
  13. 13.
    de Gruyter J, Woudenberg JHC, Aveskamp MM, Verkley GJM, Groenewald JZ, Crous PW. Redisposition of phoma-like anamorphs in Pleosporales. Stud Mycol. 2013;75:1–36.CrossRefGoogle Scholar
  14. 14.
    Dinh A, Levy B, Bouchand F, Davido B, Duran C, Cristi M, et al. Subcutaneous phaeohyphomycosis due to pyrenochaeta romeroi mimicking a synovial cyst. Front Microbiol. 2016;7:1405.CrossRefGoogle Scholar
  15. 15.
    Santos DWCL, Padovan ACB, Melo ASA, Gonçalves SS, Azevedo VR, Ogawa MM, et al. Molecular identification of melanised non-sporulating moulds: a useful tool for studying the epidemiology of phaeohyphomycosis. Mycopathologia. 2013;175:445–54.CrossRefGoogle Scholar
  16. 16.
    Garcia-Hermoso D, Valenzuela-Lopez N, Rivero-Menendez O, Alastruey-Izquierdo A, Guarro J, Cano-Lira JF, et al. Diversity of coelomycetous fungi in human infections: a 10-y experience of two European reference centres. Fungal Biol. 2019;123:341–9.CrossRefGoogle Scholar
  17. 17.
    Fraser M, Borman AM, Johnson EM. Rapid and robust identification of the agents of black-grain mycetoma by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2017;55:2521–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Division of Clinical Microbiology, Department of Laboratory MedicineUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of PathologyUniversity of Washington Medical CenterSeattleUSA
  3. 3.Department of PodiatryUniversity of Washington Medical CenterSeattleUSA
  4. 4.Division of Allergy and Infectious Diseases, Department of MedicineUniversity of Washington Medical CenterSeattleUSA

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