Recurrence of Scedosporium Apiospermum Infection Following Renal Re-Transplantation

Abstract

Immunosuppression for organ transplantation results in increased susceptibility to opportunistic infections including fungal, such as Scedosporium apiospermum. Even though many reported cases of this infection had both local and systemic manifestations, majority of the systemic infections had a fatal outcome. We report a case of a 50-year-old Caucasian male with lymphocutaneous and presumed pulmonary Scedosporium infection 4 years after renal transplantation that was successfully treated with voriconazole and discontinuation of immunosuppression. He received a second transplant 3 years later in the absence of clinical evidence of S. apiospermum infection. Unfortunately, 4 months after transplantation he developed recurrence of the same infection localizing to the soft tissues. Presently this infection is under control with surgical excision and voriconazole therapy. To our knowledge this is the first reported case of recurrent S.apiospermum infection in a renal transplant recipient. We suggest prophylactic antifungal therapy in all re-transplants with this infection.

Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist*

“…In Europe and the USA it is therefore the only type of eumycetoma which can be acquired locally, all eumycetomata by remaining agents being import mycoses. In arid climates such as India [154] and North Africa [155] the species seems to be rare. Cultures from cases of mycetoma prevalently show an abundance of the Scedosporium anamorph and rarely exhibit Graphium or ascomata [30]; occasionally they are degenerate, with detaching hyphal elements [19].…”

Recurrent Scedosporium apiospermum skin infection in a renal transplant recipient

“…Routine laboratory findings are non-specific. 4,5 The five patients here described had a moderate increase in AST/ALT during type 1 reaction. Both normalized after a course of prednisone, the same time the symptoms of the reaction cleared.…”

“…Infection with S. apiospermum is rare, although transplant recipients are considered as a risk population. [1][2][3][4] Skin infection by S. apiospermum usually presents as non-draining abscesses, sporotrichoid nodules, ulcers or tuberculoma-like infiltrative erythema. 5 Examination of samples obtained from full thickness skin confirms the diagnosis of skin involvement.…”

Emerging & Rare Fungal Infections in Solid Organ Transplant Recipients

“…In solid organ transplant recipients, Scedosporium species have been increasingly recognized as significant pathogens with substantial morbidity and mortality (8,14,46–52). Acquisition occurs from contaminated water (e.g.…”