Verruconis gallopava cardiac and endovascular infection with dissemination after renal transplantation: Case report and lessons learned

Abstract

Verruconis gallopava is an uncommon cause of phaeohyphomycosis. We describe an unusual case of disseminated V. gallopava infection in a renal transplant recipient involving the endocardium but without endocarditis, associated with fungaemia and infection in the skin, oral cavity, brain and lung. The isolate was first detected from blood cultures which is rare. Surgical resection of cardiac fungal mass was not possible. The patient died despite resolution of fungaemia and combination antifungal therapy.

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

“…Characteristically, the fungus appears as brown septate hyphae, brown unbranched conidiophores with apical denticles, and brown club‐shaped conidia with transverse septations . Verruconis spp also produces a distinctive reddish diffusible pigment on Sabouraud dextrose agar . Species identification can be confirmed with molecular biology analysis.…”

“…2,10 Verruconis spp also produces a distinctive reddish diffusible pigment on Sabouraud dextrose agar. 16 Because of its in vitro efficacy, excellent oral bioavailability, and CNS penetration, posaconazole has the ability to achieve adequate serum levels from standard dosing regimens and represents an appealing option for treating disseminated and localized phaeohyphomycoses. 13 In the use of posaconazole, clinicians need to be mindful of drug interactions, particularly with transplant medications.…”

Double invasive fungal infection due to dematiaceous moulds in a renal transplant patient

“…V. gallopava is a newly recognised mould. Previously part of the Ochronoconis genus, it is now a separate genus owing to its thermotolerance 8. Reports of V. gallopava infections are not numerous.…”

“…Reports of V. gallopava infections are not numerous. Jennings et al published a case of endovascular and cardiac infection with dissemination following renal transplantation with unfavourable outcome 8. Another report of V. gallopava published in 2015 describes necrotising pulmonary infection in an immunocompetent patient with clearance failure despite multiple courses of antifungals stretching over >5 years 9.…”

Genomic characterization of recurrent mold infections in thoracic transplant recipients

“…It is a dematiaceous, thermotolerant mold that causes zoonotic and human infection with a predilection for central nervous system invasion. In humans, it tends to infect immunocompromised hosts likely through inhalation of spores with the potential for extrapulmonary dissemination . In a series of 10 cases from the University of Pittsburgh, investigators report that all cases occurred in solid organ transplant recipients, and most occurred late after transplantation with pulmonary manifestations .…”