BI28 Phaeohyphomycosis in the immunosuppressed patients: the challenges of treatment

Abstract Phaeohyphomycosis is a group of multisystem mycoses owed to heterogeneous organisms called ‘dematiaceous’ or ‘melanized’ fungi. The presence melanin in their cell walls distinguishing feature, likely be acting as virulence factor. Widely abundant the environment, these commonly infect humans through traumatic inoculation and have many clinical forms presentation, including cutaneous, subcutaneous, systemic, rarely disseminated. Both immunocompetent immunocompromised hosts are affected. Diagnosis cutaneous infection primarily reliant on histology culture; treatment not standardized based experience. We report case 39-year-old man who presented dermatology clinic with ‘lumps’ his lower limbs. His background included poorly controlled hypertension diabetes mellitus type 2 leading nephropathy necessitating renal transplant, which failed. A 5-year period dialysis involving sedentary lifestyle was followed by repeat transplant during time he developed multiple warty-looking nodules varying size, pseudomilia cysts limbs addition stasis changes. Histology reported pigmented mould (probably phaeohyphomycosis), there no growth culture. patient trialled two azole antifungals at different times, but both occasions, dived into congestive cardiac failure needing intensive care unit admissions. Reducing immunosuppression therapy difficult considering previous failed transplant. Owing extent multiplicity lesions immunosuppression, surgical option poses significant risks. Currently, managed topical some stabilization lesions; however, it unclear how will progress future. Although uncommon, number patients phaeohyphomycosis has increased due awareness melanized fungi global COVID-19 pandemic, SARS-CoV-2, use immunosuppressive agents such glucocorticoid increasing risk infections deep mycosis. Treatment for largely been excision localized oral antifungals. Our highlights that, patients, therapeutics difficult, life-threatening complications from risks intervention ulceration, bleeding infections. In addition, cosmetic appearance prevalent noticeable relatively young also counselling vital, especially when options minimal.