A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report

<p>Abstract</p> <p>Introduction</p> <p><it>Pyrenochaeta romeroi </it>(<it>P. romeroi</it>) is a saprophytic fungus found in soil and plants. The fungal spores can be introduced into deeper tissues by trauma. It causes eumycetoma, which affects skin and subcutaneous tissues.</p> <p>Case presentation</p> <p>A 57-year-old South Asian man presented with a painless, nodular lesion (1 cm × 0.5 cm) on the left knee. He had had a renal transplant eight months earlier for end-stage renal failure. The patient was on tacrolimus, mycophenolate mofetil and prednisolone for immunosuppression. The lesion had progressed dramatically (to 5 cm × 5 cm) despite antibiotic treatment. The size and location of the lesion was severely affecting his quality of life, so an excision biopsy was performed. Nuclear ribosomal repeat-region sequencing confirmed the causative organism as <it>P. romeroi</it>. An <it>in vitro </it>antifungal susceptibility test demonstrated that <it>P. romeroi </it>was sensitive to voriconazole. Following a successful surgical removal, voriconazole was continued orally for two months.</p> <p>Conclusion</p> <p>To the best of our knowledge, we are reporting the first case of Eumycetoma caused by <it>P. romeroi </it>in a renal transplant recipient. Physicians should be aware of this rare fungal disease in transplant recipients. We recommend a combination of medical and surgical management in these immunosuppressed patients.</p