Invasive Fungal Infection Caused by Exophiala dermatitidis in a Patient After Lung Transplantation: Case Report and Literature Review

Mycopathologia. 2019 Feb;184(1):107-113. doi: 10.1007/s11046-018-0275-4. Epub 2018 Jun 11.

Abstract

This report describes a case of invasive Exophiala dermatitidis infection after double lung transplantation in a 76-year-old man. After thoracotomy, the patient's wound showed dehiscence with purulent secretion. The black yeast was isolated from cultures taken from the wound, and species identification was confirmed by sequence analysis of the internal transcribed spacer (ITS-S2) region. The results of the susceptibility testing showed voriconazole as the most active drug. Despite adaptation of the antifungal therapy the clinical condition worsened, and the patient died. In addition, we evaluated the fungicidal activity of antiseptics towards E. dermatitidis and aimed to provide a brief literature review of previously reported infections caused by this rare fungus. To the best of our knowledge, this is the first report of a rapidly progressing invasive fungal infection with E. dermatitidis originating from a colonized wound after lung transplantation.

Keywords: Exophiala dermatitidis; Invasive infection; Lung transplantation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / pharmacology
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • DNA, Ribosomal Spacer / chemistry
  • DNA, Ribosomal Spacer / genetics
  • Exophiala / classification
  • Exophiala / drug effects
  • Exophiala / genetics
  • Exophiala / isolation & purification*
  • Fatal Outcome
  • Humans
  • Immunocompromised Host*
  • Invasive Fungal Infections / diagnosis*
  • Invasive Fungal Infections / microbiology
  • Invasive Fungal Infections / pathology
  • Lung Transplantation*
  • Male
  • Microbial Sensitivity Tests
  • Phaeohyphomycosis / diagnosis*
  • Phaeohyphomycosis / microbiology
  • Phaeohyphomycosis / pathology
  • Sequence Analysis, DNA
  • Surgical Wound Infection / diagnosis*
  • Surgical Wound Infection / microbiology
  • Surgical Wound Infection / pathology
  • Voriconazole / administration & dosage
  • Voriconazole / pharmacology

Substances

  • Antifungal Agents
  • DNA, Fungal
  • DNA, Ribosomal Spacer
  • Voriconazole