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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
  • 18 Downloads

Abstract

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.

Keywords

Coelomycete Phaeohyphomycosis Medicopsis Solid-organ transplant Mycetoma Dematiaceous 

Notes

Acknowledgements

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.

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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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