A case of Verruconis gallopava infection in a heart transplant recipient successfully treated with posaconazole

Abstract

Verruconis gallopava is an environmental dematiaceous fungus that is recognized increasingly as a cause of human disease, especially for immunocompromised persons. Infection can range from superficial and localized lesions to pulmonary involvement and disseminated disease, including central nervous system abscesses. Optimal therapy is undefined. We report a patient post cardiac transplant who had pulmonary infection with V gallopava and was treated successfully with posaconazole.

A case of skin and soft tissue infection in a lung transplant recipient

“…Most cases were treated with an azole and amphotericin B. They also reported the first case of Verruconis gallapova pulmonary infection treated successfully with posaconazole monotherapy in a heart transplant recipient 3 . Similar to our experience, it was possible to avoid amphotericin and its potential toxicities.…”

“…7 Existing literature describes skin and soft tissue infection by Verruconis gallopava in individual case reports or small case series with mixed patient outcomes. 3,8,9 The optimal antifungal treatment regimen and duration of therapy is uncertain; however, long courses along with surgical debridement are essential as evidenced in this case. 10 Susceptibility testing of the Verruconis gallopava has not been standardized as a result of mixed findings of in vitro activity and MIC breakpoints.…”

“…Therefore, some authors have hypothesized that the growing use of tacrolimus immunosuppression could be contributing to the increased incidence of phaeohyphomycosis including Verruconis spp. infections 3 . A second important concept regarding tacrolimus pharmacology is its interactions with azoles.…”

“…Verruconis gallopava , previously known as Ochroconis gallopava 2 is a dematiaceous mold or “darkly pigmented fungi.” Infections with these type of fungi are termed phaeohyphomycosis and manifests as skin, lung, or central nervous system infection. Most cases have been observed in solid organ transplant recipients, 3 those with hematologic malignancies, 4 HIV infection, 5 or chronic granulomatous disease 6 . Verruconis gallopava is a thermotolerant species, found in soil, decaying vegetation, hot spring effluents, sewage from nuclear power plants, coal waste piles, and broiler‐house litters 2 .…”

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

“…As a result, we reviewed 228 published reports. We identified and included 149 reports on 201 cases of dematiaceous fungal infections in SOT recipients 21–169 . The majority (134/149; 90%) of included reports scored ≥ 2 of three possible points on our bias assessment (Table S4).…”