Phaeohyphomycosis from Exophiala jeanselmei with concomitant Nocardia asteroides infection in a renal transplant recipient: Case report and review ofthe literature

A 59-year-old black man who received a cadaveric renal transplant 15 months earlier developed subcutaneous nodules on his right upper extremity that w ere identified as phaeohyphomycosis caused by Exophiala jeanselmei. The man was admitted 4 weeks later with a swollen left arm and had Nocardia astero ides in this area and in the apex of his left lung. He was treated with sur gical excision, and itraconazole, imipenem-cilastatin, and trimethoprimsulf amethoxazole. With the potential presence of more than one microorganism in an immunocompromised patient, it is important to identify and differentiat e them correctly to direct appropriate therapy.