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Cutaneous Fusarium infection in a renal transplant recipient: a case report
© Banerji and Singh J; licensee BioMed Central Ltd. 2011
Received: 19 May 2010
Accepted: 25 May 2011
Published: 25 May 2011
Fungal infections in the immunocompromised host are fairly common. Of the mycoses, Fusarium species are an emerging threat. Fusarium infections have been reported in solid organ transplants, with three reports of the infection in patients who had received renal transplants. To the best of our knowledge, this is the first case of an isolated cutaneous lesion as the only form of infection.
We report the case of a 45-year-old South Indian man who presented with localized cutaneous Fusarium infection following a renal transplant.
In an immunocompromised patient, even an innocuous lesion needs to be addressed with the initiation of prompt treatment.
Fusarium species are common soil saprophytes and plant pathogens. Young and Meyers  first reported Fusarium infection in the late 1970s. Since then, several species have been recognized to be agents of superficial infections (keratitis, cutaneous infections, onychomycosis and infection of wounds or burns) in humans . More recently, deep-seated, disseminated infections have been increasingly described in immunocompromised patients, especially in neutropenic patients [3, 4]. The prognosis is very poor, and death occurs in up to 70% of the cases despite antifungal therapy . The Fusarium species most frequently involved in human infections are Fusarium solani, F. oxysporum and F. moniliforme.
Fusarium species are ubiquitous and may be found in the soil and air and on plants. In humans, Fusarium species cause disease that is localized, focally invasive or disseminated. The pathogen generally affects immunocompromised individuals, with infection of immunocompetent persons being rarely reported. Localized infection includes septic arthritis, endophthalmitis, osteomyelitis, cystitis and brain abscess. In these situations, a relatively good response may be expected following appropriate surgery and oral antifungal therapy. Disseminated infection occurs when two or more noncontiguous sites are involved . The skin can be an important and early clue to diagnosis, since cutaneous lesions may be observed at an early stage of the disease. Typical skin lesions may be painful red or violaceous nodules, the center of which often becomes ulcerated and covered by a black eschar. The multiple necrotizing lesions are often observed on the trunk and the extremities .
Our patient had a single, localized nodule that was treated successfully with surgical excision and antifungal therapy. He did not have any signs of disseminated infection. At the last follow-up appointment, he had no symptoms of any disseminated fungemia. Amphotericin has been the drug of choice to treat most fungal infections. The use of azoles, namely, voriconazole, posaconazole and ravuconazole, has also been found to be promising . As the patient was a renal transplant recipient, we chose to use voriconazole to treat him as it has shown good response in most zygomycoses.
Opportunistic infections in transplant recipients can be life-threatening. Fusarium infections are recognized more often, and unless they are diagnosed and treated early, they can be a cause of significant morbidity and mortality.
Written, informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We acknowledge the contribution of Dr. Sanjeev Shah from the Department of Pathology.
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