scholarly journals Chromoblastomycosis Due to a Never-before-Seen Dematiaceous Fungus in a Kidney Transplant Patient

2021 ◽  
Vol 9 (10) ◽  
pp. 2139
Author(s):  
Hélène Guegan ◽  
Marine Cailleaux ◽  
François Le Gall ◽  
Florence Robert-Gangneux ◽  
Jean-Pierre Gangneux
Keyword(s):  
Kidney Transplant ◽  
Subcutaneous Tissue ◽  
Complete Healing ◽  
Lower Limbs ◽  
Kidney Transplant Patient ◽  
Immunosuppressed Patient ◽  
Dematiaceous Fungi ◽  
Dematiaceous Fungus ◽  
Microscopic Features ◽  
Mycological Examination

Chromoblastomycosis is a neglected fungal infection of the epidermis and subcutaneous tissue that predominates in tropical areas and results from the traumatic inoculation of environmental dematiaceous filamentous fungi. We describe the case of an immunosuppressed patient diagnosed with foot chromoblastomycosis due to an uncommon dematiaceous fungus. A 52-year-old Congolese kidney transplant woman presented with a painful lesion located on the foot. No trauma to the lower limbs was reported during the previous months. She lived in France and had not returned to the Congo over the previous eight years. Histology and mycological examination from skin biopsy revealed swollen dark filaments associated with dematiaceous muriform cells, pathognomonic of chromoblastomycosis. Cultures grew with dark pigmented colonies, yielding poor microscopic features. The phylogenetic analysis confirmed that the isolate was a member of Kirschsteiniotheliales (Dothideomycetes) and unrelated to the Chaetotyriales, of which most species commonly responsible for chromoblastomycosis belong. As there was no bone spreading, excision surgery of the entire lesion followed by liposomal amphotericin B therapy resulted in complete healing after six months. This original case illustrates the potential diversity of environmental dematiaceous fungi responsible for phaeohyphomycosis, especially chromoblastomycosis, and the need to send samples to mycology labs for appropriate diagnosis.

scholarly journals Majocchi’s Granuloma on the Forearm Caused by Trichophyton tonsurans in an Immunocompetent Patient

2020 ◽  
Author(s):  
Yun-yan Zheng ◽  
Yue Li ◽  
Ming-yan Chen ◽  
Qian-yun Mei ◽  
Ru-zhi Zhang
Keyword(s):  
Trichophyton Rubrum ◽  
Subcutaneous Tissue ◽  
Immunocompetent Patient ◽  
Lower Limbs ◽  
Trichophyton Tonsurans ◽  
Anterior Aspect ◽  
Majocchi’S Granuloma ◽  
Mycological Examination ◽  
Dermal Infiltrate ◽  
A Site

Abstract Majocchi's granuloma is an uncommon fungal infection of the dermis and subcutaneous tissue. The most frequently identified cause of Majocchi’s granuloma is anthropophilic Trichophyton rubrum, and it is most commonly located on the anterior aspect of the lower limbs in women. Here, we report a case of Majocchi’s granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed a dense dermal infiltrate composed of lymphoplasmacytic cells and neutrophils, with hyphae in the dermis. The presence of the fungus, Trichophyton tonsurans, was confirmed by mycological examination. Therefore, histological and mycological examination conformed the diagnosis of Majocchi’s granuloma. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which facilitated a complete resolution of the lesions

Cerebral Phaeohyphomycosis Due to Cladophialophora Bantiana in a Kidney Transplant Patient

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S135-S136
Author(s):  
K Yu ◽  
P Devi ◽  
R Pulinthanathu
Keyword(s):  
Kidney Transplant ◽  
Antifungal Therapy ◽  
Peripheral Vision ◽  
Fungal Infections ◽  
Histopathological Examination ◽  
Kidney Transplant Patient ◽  
Solid Organ ◽  
Status Change ◽  
Dematiaceous Fungi ◽  
Brain Abscesses

Abstract Casestudy: Phaeohyphomycosis is a group of infections caused by pigmented, black, dematiaceous fungi and is responsible for cutaneous, superficial and deep mycoses, disseminated infection and brain abscesses. The primary agents involved include Alternaria spp., Exophiala spp. and Cladophialophora spp. Cerebral phaeohyphomycosis is particularly devastating with mortality rates as high as 70-80%. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We report a case of cerebral phaeohyphomycosis in a 65-year-old male with living donor kidney transplant for four years and has been maintained on immunosuppressive therapy with tacrolimus and prednisone. The patient presented with aphasia, frontal headache, loss of peripheral vision of right eye, and mental status change for three months due to several left- sided parieto-occipital brain abscesses. Left occipital abscess resection and parietal partial lobectomy were performed to reduce intracranial hypertension and to remove abscesses. Histopathological evaluation revealed brain abscess with pigmented fungal organisms with elongated, branched and septate. The pus aspirated during surgical excision of brain lesions grew black mold, identified as Cladophialophora bantiana. The patient’s neurological neurological condition had imporved after several weeks of combination antifungal therapy with posaconazole, liposomal amphotericin, and flucytosine. The lesions were initially suspected to be of tuberculous etiology, which was ruled out by histopathological examination. Such diagnostic dilemmas are common in the infection caused by Cladophialophora, which can cause treatment delay and death. Early diagnosis is therefore mandatory for the rapid treatment and survival of patients. As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.

scholarly journals Majocchi’s Granuloma on the Forearm Caused by Trichophyton tonsurans in an Immunocompetent Patient

2020 ◽  
Author(s):  
Yun-yan Zheng ◽  
Yue Li ◽  
Ming-yan Chen ◽  
Qian-yun Mei ◽  
Ru-zhi Zhang
Keyword(s):  
Trichophyton Rubrum ◽  
Subcutaneous Tissue ◽  
Immunocompetent Patient ◽  
Lower Limbs ◽  
Trichophyton Tonsurans ◽  
Anterior Aspect ◽  
Majocchi’S Granuloma ◽  
Mycological Examination ◽  
Dermal Infiltrate ◽  
A Site

Abstract Majocchi's granuloma is an uncommon fungal infection of the dermis and subcutaneous tissue. The most frequently identified cause of Majocchi’s granuloma is anthropophilic Trichophyton rubrum, and it is most commonly located on the anterior aspect of the lower limbs in women. Here, we report a case of Majocchi’s granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed a dense dermal infiltrate composed of lymphoplasmacytic cells and neutrophils, with hyphae in the dermis. The presence of the fungus, Trichophyton tonsurans, was confirmed by mycological examination and molecular methods. Therefore, histological and mycological examination confirmed the diagnosis of Majocchi’s granuloma. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which facilitated a complete resolution of the lesions.

scholarly journals Safe Administration of Cemiplimab to a Kidney Transplant Patient with Locally Advanced Squamous Cell Carcinoma of the Scalp

2021 ◽  
Vol 28 (1) ◽  
pp. 574-580
Author(s):  
Luca Paoluzzi ◽  
Thomas J Ow
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Kidney Transplant ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Kidney Transplant Patient ◽  
Cell Transplant ◽  
Renal Transplant Recipients ◽  
Advanced Squamous Cell Carcinoma ◽  
Hematopoietic Stem

Immunotherapies directed at T-cell activation through antibodies targeting checkpoint proteins, such as programmed cell death 1 (PD1), are rapidly becoming the new standard of care in the treatment of several malignancies. Cemiplimab is a monoclonal antibody targeting PD1 that has recently emerged as a highly active treatment for locally advanced and metastatic cutaneous squamous cell carcinoma (CSCC). Patients who have received an organ transplant (OTRs) have been traditionally excluded from clinical trials with checkpoint inhibitors (CIs), given concerns for organ rejection. Renal transplant recipients (RTRs) are more likely to develop cancers than the general population, and skin cancers are among the most frequent malignancies. We report the case of a 72-year-old man with a history of a kidney transplant who presented with a rapidly growing, locally advanced squamous cell carcinoma (SCC) of the scalp that recurred within four weeks from surgical resection. The patient was able to safely receive ten cycles of cemiplimab so far with significant clinical benefit, and no issues with his kidney function, while continuing immunosuppression with low dose prednisone alone. An ongoing clinical trial (NCT04339062) is further exploring the safety of CIs in patients with metastatic CSCC who have previously received allogeneic hematopoietic stem cell transplant or a kidney transplant.

Reduced venous compliance in lower limbs of aging humans and its importance for capacitance function

1998 ◽  
Vol 275 (3) ◽  
pp. H878-H886 ◽  
Author(s):  
Henrik Olsen ◽  
Toste Länne
Keyword(s):  
Muscle Tissue ◽  
Negative Pressure ◽  
Lower Body Negative Pressure ◽  
Subcutaneous Tissue ◽  
Lower Limbs ◽  
Venous Compliance ◽  
Reduced Pressure ◽  
Pressure Transmission ◽  
Circulatory Stress ◽  
Capacitance Response

Venous compliance in the calf of humans and its importance for capacitance function in relation to age were studied with the aid of 22, 44, and 59 mmHg lower body negative pressure (LBNP). Negative pressure transmission to the calf as well as changes in calf volume were studied, and venous compliance was calculated [change in volume with pressure change (dV/dP)]. The change in capacitance response of the calf with age (20–70 yr) was evaluated during LBNP 44 mmHg. Transmission of negative pressure to the subcutaneous tissue was almost full without any changes with age (92%). However, it was reduced to 80% in the underlying muscle tissue, irrespective of depth. Venous compliance in the young was 0.051 ml ⋅ 100 ml−1 ⋅ mmHg−1and was reduced by 45% to 0.029 ml ⋅ 100 ml−1 ⋅ mmHg−1in the old ( P < 0.05). Accordingly, the capacitance response was reduced by 0.015 ml ⋅ 100 ml−1 ⋅ yr−1( P < 0.005). Furthermore, the hemodynamic response to hypovolemic circulatory stress was attenuated with age. The reduced pressure transmission in muscle tissue is probably due to restriction of the muscle fascia envelope. The reduced venous compliance with age and the concomitant reduction in capacitance response during LBNP have implications for both the sympathetic reflex responses as well as the capacitance response during acute hypovolemic circulatory stress, which might be defected in aging humans.

scholarly journals How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

2020 ◽  
Vol 35 (6) ◽  
pp. 899-904 ◽  
Author(s):  
Umberto Maggiore ◽  
Daniel Abramowicz ◽  
Marta Crespo ◽  
Christophe Mariat ◽  
Geir Mjoen ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Expert Opinion ◽  
Transplant Patient ◽  
Kidney Transplant Patient

Tacrolimus—Itraconazole Interaction in a Kidney Transplant Patient

2000 ◽  
Vol 34 (4) ◽  
pp. 536-536 ◽  
Author(s):  
María Outeda Macías ◽  
Pilar Salvador ◽  
Juan L Hurtado ◽  
Isabel Martín
Keyword(s):  
Kidney Transplant ◽  
Transplant Patient ◽  
Kidney Transplant Patient

scholarly journals POS-720 Atypical Cause of Pancytopenia in a Kidney Transplant Patient.

2021 ◽  
Vol 6 (4) ◽  
pp. S314-S315
Author(s):  
G. GEMBILLO ◽  
F. D'Ignoto ◽  
P. Salis ◽  
D. Santoro ◽  
R. Liotta ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Patient ◽  
Kidney Transplant Patient
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