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