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Cutaneous Purpureocillium lilacinum and Fusarium coinfection in a heart transplant recipient

Summary

A heart transplant patient developed multiple nodular skin lesions caused by two rare types of mold fungi growing together. Doctors diagnosed the infection through skin biopsy and identified the fungi using laboratory techniques. The patient was successfully treated with the antifungal medication voriconazole for six months and made a full recovery without relapse.

Background

Invasive fungal infections are a significant cause of morbidity and mortality in solid organ transplant recipients, with heart transplant recipients at approximately 4% risk. While Candida and Aspergillus remain most common, infections with rare moulds including Purpureocillium lilacinum and Fusarium are increasingly reported as important opportunistic pathogens.

Objective

To report a rare case of coinfection with Purpureocillium lilacinum and Fusarium species in a heart transplant recipient and highlight the importance of accurate diagnosis and appropriate antifungal selection.

Results

Both P. lilacinum and Fusarium species were isolated from skin samples. Histopathology revealed necrotising granulomas with fungal spores and hyphae. The patient was treated with voriconazole 400 mg twice daily followed by 200 mg twice daily with therapeutic drug monitoring. Skin lesions resolved within two months, and the patient remained disease-free after completing 6 months of treatment.

Conclusion

This case demonstrates the complexity of mixed invasive fungal infections in transplant recipients and emphasizes the importance of heightened clinical awareness, accurate diagnostics, and selection of appropriate antifungal therapy such as voriconazole for rare mould coinfections.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39161845, DOI: 10.1016/j.mmcr.2024.100664
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