Mycopathologia 125: 153-156, 1994. © 1994 KluwerAcademic Publishers. Printedin the Netherlands. Subcutaneous Pseudallescheriasis in a renal transplant recipient J.O. Lopes, S.H. Alves, J.P. Benevenga, A. Salla, C. Khmohan & C.B. Silva University Hospital, Santa Maria, RS, Brazil Received 13 August 1993; accepted in revised form 16 December 1993 Abstract. This paper reports a case of a single subcutaneous nodule caused by Pseudallescheria boydii in a renal transplant recipient, possibly of nontraumatic origin. The patient was treated surgically and with itraconazole. Key words: PseudalIescheria boydii, Renal transplant recipient, Subcutaneous nodule Introduction Fungal infection has long been an important problem among renal transplant recipients be- cause the protection of a transplanted kidney de- pends on the suppression of cell mediated immun- ity, which is responsible for graft rejection [1]. In recent years, management of immunosuppression has resulted in fewer fatal cases, but fungal infec- tions are still a problem during the first months following renal transplantation [2]. These patients may develop a systemic infection due to reacti- vation of a latent focus [3-5] or a primary oppor- tunistic fungal infection [6-10]. It is known that in systemic fungal infections, mucous mem- branes, skin and subcutaneous tissue may be in- volved. In few cases, however, the subcutaneous involvement may be presented without other evi- dence of disseminated disease [11]. We report a case of a single subcutaneous nodule caused by Pseudallescheria boydii, possibly of nontraumatic origin, in a renal transplant recipient treated sur- gically and with itraconazole. Case report A 45-year-old white man has been hypertensive since 1988. He developed end-stage renal failure and in September 1992, he received a renal trans- plant from a haploidentical sister at the Nephrol- ogy Department of the Santa Maria University Hospital. The immunosuppressive medications were: prednisone, azathioprine and cyclosporine. On third day after transplantation, an episode of acute graft rejection was treated with metilpredni- solone. In December 1992, he developed diabetes mellitus (serum glucose level 576 mg/dl) and was treated with insulin. In January 1993, he noticed a painless subcutaneous nodule measuring 0.5 cm in diameter in the internal side of the left knee. He denied previous trauma of the region and there was no break in skin integrity. He had no- ticed a gradual increase in size of the nodule in the prior three months and in April 1993, examin- ation revealed a painelss tender fluctuant nodule, measuring 2 cm in diameter, recovered with intact skin and without adenopathy. The patient has complained about formication at the site and in- stability on knee articulation. A surgical resection performed in May 1993, made evident a cyst with a serous content, a dense histiocytic infiltration and rare hyphae (Fig. 1). Aerobic and anaerobic cultures and gram stain of the cyst content were negative but on BHI broth, at 6th day incubation, a filamentous fungus was disclosed. Subcultures on Sabouraud's dextrose agar incubated at 25 and 37 °C allowed the growth of a white fluffy mould.