SOFT TISSUE INFECTION DUE TO MYCELIOPHTHORA SPP. IN A LIVER/KIDNEY TRANSPLANT RECIPIENT

Lombardi G.1 , F. Luzzaro 1 , A. Toniolo 1 , M.G. Rinaldi 2 , P. Grossi 1

Author address: 

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Abstract: 

We report a case of infection in a solid organ transplant recipient caused by Myceliophthora spp. The patient (a 66-year male) underwent liver transplantation in 1995 in Belgium and kidney transplantation in March 2002 in a major transplantation unit in Northern Italy. The kidney transplant was complicated by acute vascular rejection that was unsuccessfully treated with steroids and OKT3. At the beginning of OKT3 administration, the patient was treated pre-emptively with liposomal amphotericin B (Ambisome ® , 50 mg/day). The kidney graft was explanted five weeks later. At surgery, an aneurysm of the iliac artery was removed and cultured. Based on the isolation of a filamentous fungus (initially misidentified as Aspergillus spp.), the dosage of Ambisome ® was increased to 200 mg/day. The patient developed multiple nodules at the right leg, suggestive for dissemination of infection. After discharge, the patient was admitted to the Department of Infectious Diseases of our University Hospital. The mould colony, initially powdery and whitish, becoming cottony and pale brown after 7-14 days, was temptatively identified as Scedosporium apiospermum, which is known to be resistant to amphotericin B. The treatment was thus switched to voriconazole (4 mg/kg bid iv). Leg lesions improved after a few days of treatment. The isolate was sent to Dr. Rinaldi’s Laboratory where it was identified as Myceliophthora spp. Antifungal susceptibility testing revealed that the strain had limited susceptibility to amphotericin B (MIC: 2 µg/ml at 48 h), whereas it was very susceptible to both voriconazole and posaconazole (MIC values at 48 hr:
2003

abstract No: 

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Full conference title: 

The 15 th Congress of the International Society for Human and Animal Mycology
    • ISHAM 15th (2003)