Recurrent Cutaneous Fusariosis in a Kidney Transplant Recipient – a Case Report and Review of the Literature

Abstract

**Introduction:** We report an unusual case of cutaneous fusariosis in a kidney transplant recipient. *Fusarium* species are emerging fungal pathogens that pose diagnostic and therapeutic challenges. In severely immunocompromised patients, fusarial infections are associated with high mortality in the case of systemic dissemination. **Case presentation:** A 69-year-old black male with a history of renal transplantation presented with recurrent purulent nodules and painful ulcers of the left lower leg. Based on repeated skin biopsies, focally invasive skin infection with *Fusarium solani* was proven histologically and microbiologically. After four months of treatment with oral voriconazole, lesions considerably improved. When the patient died one month later from Covid-19 pneumonia under continued antifungal therapy, there was no evidence of systemic fusariosis or fusarial superinfection. **Conclusion:** Although rare, fusarial infections should be considered in immunocompromised individuals such as solid organ transplant recipients. Therefore, skin lesions in this patient population should be examined accurately. Histopathological and microbiological workups, including fungal cultures, are necessary for diagnosis and timely initiation of targeted therapy. Systemic antifungal therapy with voriconazole is the treatment of choice for focally invasive fusariosis.