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.
Similar content being viewed by others
References
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.
Sutton DA. Coelomycetous fungi in human disease. A review: clinical entities, pathogenesis, identification and therapy. Rev Iberoam Micol. 1999;16:171–9.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Handling Editor: Patrick C. Y. Woo.
Rights and permissions
About this article
Cite this article
Lieberman, J.A., Fiorito, J., Ichikawa, D. et al. Long-Term Carriage of Medicopsis romeroi, an Agent of Black-Grain Mycetoma, Presenting as Phaeohyphomycosis in a Renal Transplant Patient. Mycopathologia 184, 671–676 (2019). https://doi.org/10.1007/s11046-019-00379-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11046-019-00379-y