Dematiaceous Fungal Infections in Kidney Transplant Recipients – Case Series

Abstract

This retrospective, single-center study analyzed the clinical profile and outcomes of dematiaceous fungal infections in kidney transplant recipients over a 12-year period (2010–2022). Out of 1,041 transplant recipients, 69 developed major fungal infections, with dematiaceous fungi accounting for 8.6% of cases (n=6). These infections affected predominantly middle-aged adults (mean age 47 ± 13.1 years), with a slight male predominance. Most patients received kidneys from live-related donors and were maintained on standard immunosuppressive regimens. Dematiaceous fungal infections manifested on average 3.43 ± 1.8 years post-transplant, presenting as skin lesions, arthritis, or sinusitis. Diagnosis was confirmed through culture and histopathology, revealing phaeohyphomycosis in most cases. Management included long-term oral itraconazole therapy with regular monitoring; only one patient experienced a recurrence after five years. The findings underscore the need for heightened clinical suspicion in transplant recipients presenting with atypical skin or joint lesions, and highlight the importance of early microbiological and histopathological assessment. Prompt antifungal therapy, often alongside surgical intervention, is essential to prevent disease progression.

Keywords

• dematiaceous fungi
• itraconazole
• kidney transplant recipients
• phaeohyphomycosis