Diagnostic pitfalls in cytological diagnosis of subcutaneous fungal infection in renal transplant recipients

Abstract

Renal transplant recipients (RTRs) are at increased risk of the development of a variety of skin infections that can result from graft-preserving immuno-suppressive therapy. In this study, we aimed to determine cytomorphological findings of fungal subcutaneous swelling in seven RTRs and to analyze diagnostic pitfalls in fungal cytology. A retrospective review of fine needle aspiration cytology (FNAC) smears of subcutaneous swelling with positive fungal elements in RTRs from 2008 to 2010 was performed. We had seven cases (all males; age range, 34-58 years, mean, 46.3 years). The time interval between the renal transplantation and appearance of swelling ranged from 8 to 19 months (mean, 13.4 months). The swelling was located on lower limb (six cases) and arm (one case). The lesion was solitary (six cases) and multiple (one case). The cytology of aspirated material showed branched septate fungal hyphae in six cases. These were well delineated on Periodic acid schiffs (PAS) and chromic silver methenamine (CSM) stains. One case showed presence of faint, thin walled, broad ribbon like hyphae. Culture of aspirated material was performed in four cases which grew phaeohyphomycosis in all. Histology of excised tissue showed numerous septate, branched, pigmented fungal elements suggestive of pheohyphomycosis in four cases and broad ribbon hyphae suggestive of zygomycosis in one case. All of our cases responded well with anti-fungal treatment. Fungal infection can manifest as subcutaneous swelling in RTRs. It is often severe, rapidly progressive and difficult to diagnose. FNAC is an important diagnostic tool which is simple, cost effective and rapid method.

Phaeohyphomycosis breast masquerading as fibroadenoma in a young teenage girl

“…In the present case, the species delineated was Exophiala dermatitidis . It presents as a disseminated disease or as focal involvement of one or more systems: sinusitis, onychomycosis, subcutaneous lump, corneal inflammation, osteomyelitis, pneumonia, cerebral abscesses, lung, heart and skin . The rare case involving hard palate has been reported by Yeshwent et al The present case presented with a lump in the breast which is extremely rare and on the extensive literature search, no case with similar presentation could be found on FNAC.…”

“…It presents as a disseminated disease or as focal involvement of one or more systems: sinusitis, onychomycosis, subcutaneous lump, corneal inflammation, osteomyelitis, pneumonia, cerebral abscesses, lung, heart and skin. [1][2][3][4][5] The rare case involving hard palate has been reported by Yeshwent et al 6 The pres- We report a rare case of phaeohyphomycosis presenting as a breast lump masquerading as fibroadenoma which has not been reported in the literature. The awareness of such organisms in cytology smears will fasten the diagnosis leading to early treatment which is a necessity, especially in disseminated cases as the disease has high morbidity and mortality.…”

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

“…An additional 246 cases were identified in 28 reports, but they did not meet our inclusion criteria (Table S5). 9,58,80,140,162,165,170–191 Characteristics of cases included in the present analysis are presented in Table 1. Proven fungal infections accounted for 96% (193/201) of cases, six cases were probable, and two cases were possible.…”

Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases

“…The hyphae are slender, having variable length and irregular breadth. They are 2- to 6-µm wide with close septations, often with constrictions, pseudohyphae, and yeast-like forms [15]. Terminal bulbous vesicular swellings may be seen.…”

“…Differential diagnoses of phaeohyphomycosis include chromoblastomycosis and mycetoma, although some confusion with Aspergillus and Mucoromycetes may occur [2, 14, 15]. Patients with mycetoma clinically present with discharging sinuses and granules, unlike cases of phaeohyphomycosis, where the overlying skin is usually intact.…”