Phaeohyphomycosis caused by Exophiala oligosperma in liver transplant recipient: case report and literature review.

Phaeohyphomycosis (PHM) is a fungal infection caused by a group of dematiaceous (darkly pigmented) fungi. In this study, we describe a successfully treated case of PHM caused by Exophiala oligosperma in a 68-year-old liver transplant recipient who presented with painful erythematous subcutaneous nodules on his lower left limb. Treatment involved a combination of antifungal drugs and surgical excision. We performed review of 13 cases of PHM in liver transplant recipients reported from 2000 to 2024. Eight patients presented with skin and subcutaneous tissue involvement and limbs were the most frequently affected areas. The median time after liver transplant to the diagnosis of PHM was 6 months. Laboratory diagnosis mainly relied on histopathology. Eleven patients received systemic antifungal therapy and seven underwent surgical excision. Full recovery was observed in eleven cases. Altogether, PHM in solid organ transplant recipients is a rare infection and early diagnosis is critical for a favorable outcome.