Case report Multifocal phaeohyphomycosis caused by Exophiala xenobiotica in a kidney transplant recipient A. Palmisano, F. Morio, P. Le Pape, A.M. Degli Antoni, R. Ricci, A. Zucchi, A. Vaglio, G. Piotti, R. Antoniotti, E. Cremaschi, C. Buzio, U. Maggiore. Multifocal phaeohyphomycosis caused by Exophiala xenobiotica in a kidney transplant recipient. Transpl Infect Dis 2015. All rights reserved Abstract: In recent years, black fungi have been increasingly reported as causing opportunistic infections after solid organ transplantation. Here, we report a case of insidious, relentless, and multifocal Exophiala xenobiotica infection in a kidney transplant recipient that eventually required multiple surgical excisions along with oral and intravenous antifungal combination therapy using liposomal amphotericin B and posaconazole. We compare the present case with all previously reported cases of Exophiala infection after kidney transplantation. A. Palmisano 1 , F. Morio 2,3 , P. Le Pape 2,3 , A.M. Degli Antoni 4 , R. Ricci 5 , A. Zucchi 6 , A. Vaglio 1 , G. Piotti 1 , R. Antoniotti 1 , E. Cremaschi 1 , C. Buzio 1 , U. Maggiore 1 1 Transplant Nephrology Unit, University Hospital, Parma, Italy, 2 Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France, 3 Department of Parasitology and Medical Mycology, EA1155 IICiMed, University of Nantes, Nantes, France, 4 Infectious Diseases Unit, University Hospital, Parma, Italy, 5 Pathology Unit, University Hospital, Parma, Italy, 6 Dermatology Unit, University Hospital, Parma, Italy Key words: kidney transplant recipient; phaeohyphomycosis; Exophiala; black fungi; antimycotic therapy Correspondence to: Dr Alessandra Palmisano, Unit a Operativa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy Tel: +39 0521 702918 Fax: +39 0521 033185 E-mail: picula79it@yahoo.it Received 14 June 2014, revised 18 September 2014, 3 December 2014, accepted for publication 10 December 2014 DOI: 10.1111/tid.12350 Transpl Infect Dis 2015: 0: 1–6 Serious infections caused by a variety of opportunistic fungi are increasingly reported in solid organ transplant (SOT) recipients (1). As these now represent approx- imately 7–10% of fungal infections among SOT recipi- ents, they are collectively considered as “emerging fungal infections.” Current knowledge on their epide- miology, clinical course, and antifungal management strategies is limited (1, 2). Phaeohyphomycosis, one of the least known emerging fungal infection in SOT, which is diagnosed by the identification of dark- pigmented fungal elements in histopathologic samples from infected tissues, is produced by various black fungi (sometimes referred as “dematiaceous”) such as Exophiala, Alternaria, or Bipolaris species. These species may cause pleomorphic infections ranging from allergic diseases (mostly involving the respiratory tract) and superficial subcutaneous infections to fatal disseminated diseases (3, 4). In this report, we present a new case of disseminated Exophiala xenobiotica infection in a kidney transplant recipient that did not respond to prolonged azole therapy (fluconazole followed by voriconazole). The 1 © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Transplant Infectious Disease, ISSN 1398-2273