Sporotrichosis in renal transplant patients : two case reports and a review of the literature
Date
2020-06-26
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Introduction: Sporotrichosis is a rare fungal infection in transplant patients; among these patients, it occurs mostly
in renal transplant patients. Sporothrix schenkii is the primary pathogen responsible. A high index of suspicion is
required to make the diagnosis keeping important differential diagnoses in mind. History of trauma through
recreational or occupational exposure to the fungus may assist in making the diagnosis. Treatment is difficult, with
long-term use of potentially nephrotoxic and cytochrome P450 inhibitor antifungal agents leading to potential
calcineurin inhibitors toxicity. We describe two renal transplant patients presenting with distinct sporotrichosis
infection: “Case 2” being only the second reported case ever of meningeal sporotrichosis. We subsequently review
the general aspects of sporotrichosis, specifically in renal transplant patients as described in the medical literature.
Case presentation: Case 1, a 43-year-old mixed ancestry male patient presented with a non-healing ulcer on the
left arm for 1 year, he was diagnosed with cutaneous sporotrichosis and was successfully treated with itraconazole
monotherapy. Case 2, a 56-year-old mixed ancestry male patient presented with a slow decline in functions,
confusion, inappropriate behavior, rigors and significant loss of weight and appetite over the past 4 months, he was
diagnosed with meningeal sporotrichosis and was successfully treated with a combination of deoxycholate
amphotericin B and itraconazole.
Conclusion: Physicians taking care of renal transplant patients should have a high index of suspicion for
sporotrichosis infection particularly when conventional therapy for common conditions fails. Susceptibility testing is
recommended to identify the most effective antifungal agent and its dose. The slow nature of growth of Sporothrix
schenkii necessitates patients to be on amphotericin B until the time results are available. Finally, there is a need to
be aware of potential drug-drug interactions of the azoles with calcineurin inhibitors and the required dose
adjustments to prevent therapy related adverse events.
Description
CITATION: Amirali, M. H., et al. 2020. Sporotrichosis in renal transplant patients : two case reports and a review of the literature. Journal of Medical Case Reports, 14:79, doi:10.1186/s13256-020-02385-x.
The original publication is available at https://jmedicalcasereports.biomedcentral.com
The original publication is available at https://jmedicalcasereports.biomedcentral.com
Keywords
Sporotrichosis, Renal tubular transport, Fungal infections
Citation
Amirali, M. H., et al. 2020. Sporotrichosis in renal transplant patients : two case reports and a review of the literature. Journal of Medical Case Reports, 14:79, doi:10.1186/s13256-020-02385-x