Respiratory Tract Infection Caused by Fonsecaea monophora After Kidney Transplantation Isabella Barbosa Cleinman . Sarah Santos Gonc ¸alves . Marcio Nucci . Danielle Carvalho Quintella . Ma ´rcia Halpern . Tiyomi Akiti . Glo ´ria Barreiros . Arnaldo Lopes Colombo . Guilherme Santoro-Lopes Received: 18 December 2016 / Accepted: 17 June 2017 Ó Springer Science+Business Media B.V. 2017 Abstract Fonsecaea spp. are melanized fungi which cause most cases of chromoblastomycosis. The tax- onomy of this genus has been revised, now encom- passing four species, with different pathogenic potential: F. pedrosoi, F. nubica, F. pugnacius, and F. monophora. The latter two species present wider clinical spectrum and have been associated with cases of visceral infection, most often affecting the brain. To our knowledge, this is the first report of proven case of F. monophora respiratory tract infection. A Brazilian 57-year-old-female patient underwent kidney trans- plantation on January 12, 2013. On the fourth postop- erative month, the patient presented with fever, productive cough, and pleuritic pain in the right hemithorax. A thoracic CT scan showed a subpleural 2.2-cm nodular lesion in the right lung lower lobe, with other smaller nodules (0.5–0.7 cm) scattered in both lungs. Bronchoscopy revealed a grayish plaque on the right bronchus which was biopsied. Micro- scopic examination demonstrated invasion of bron- chial mucosa by pigmented hyphae. Culture from the bronchial biopsy and bronchoalveolar lavage samples yielded a melanized mold, which was eventually identified as F. monophora. She started treatment with voriconazole (400 mg q.12h on the first day, followed by 200 mg q.12h). After 4 weeks of therapy, voriconazole dose was escalated to 200 mg q.8h and associated with amphotericin B (deoxycolate 1 mg/ kg/day) because of a suspected dissemination to the brain. The patient eventually died of sepsis 8 weeks after the start of antifungal therapy. In conclusion, F. monophora may cause respiratory tract infection in solid organ transplant recipients. Keywords Fonsecaea monophora Á Lung nodule Á Transplantation Á Immune suppression Electronic supplementary material The online version of this article (doi:10.1007/s11046-017-0168-y) contains supple- mentary material, which is available to authorized users. I. B. Cleinman Á M. Halpern Á G. Santoro-Lopes (&) Clı ´nica de Doenc ¸as Infecciosas e Parasita ´rias, Hospital Universita ´rio Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Justiniano da Rocha 201/302, Vila Isabel, Rio de Janeiro, RJ CEP 20551-010, Brazil e-mail: santorolopes@hucff.ufrj.br S. S. Gonc ¸alves Departamento de Patologia, Centro de Investigac ¸o ˜es em Micologia Me ´dica (CIMM), Universidade Federal do Espı ´rito Santo, Vito ´ria, Brazil M. Nucci Á T. Akiti Á G. Barreiros Laborato ´rio de Micologia, Hospital Universita ´rio Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil D. C. Quintella Departmento de Patologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 123 Mycopathologia DOI 10.1007/s11046-017-0168-y