Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney360
    • Kidney News Online
    • American Society of Nephrology
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Advertisement
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Podcasts
    • Subject Collections
    • Archives
    • ASN Meeting Abstracts
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Author Resources
  • Trainees
    • Peer Review Program
    • Prize Competition
  • About CJASN
    • About CJASN
    • Editorial Team
    • CJASN Impact
    • CJASN Recognitions
  • More
    • Alerts
    • Advertising
    • Feedback
    • Reprint Information
    • Subscriptions
  • ASN Kidney News
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum

About the Cover

June 08, 2020; Volume 15,Issue 6

Cover image

Cover image expansion

On the Cover

What is the diagnosis?

A 50-year-old male from Sudan, with a history of vitiligo and kidney failure secondary to hypertensive nephrosclerosis after a living unrelated donor kidney transplant 2 years prior, presented to the clinic for evaluation of a skin lesion. On examination, there was a smooth, multilobulated, pink, nontender nodule on the left fifth metatarsal head (left). A biopsy revealed phaeohyphomycosis caused by Medicopsis romeroi, as ascertained by culture. Two years later, he returned to the clinic reporting that his vitiligo had begun to spread to involve his upper back, head, and neck (center). A biopsy revealed keratinocytes with pale blue cytoplasm, multiple keratohyalin granules, and a thickened granular layer, features consistent with epidermodysplasia verruciformis (EDV) (right).

Key teaching points

Phaeohyphomycoses refer to cutaneous and subcutaneous infections caused by various groups of dematiaceous fungi (Revankar and Sutton 2010). Infection caused by M. romeroi in solid organ transplant recipients is rare but tends to affect people from West Africa and Asia. M. romeroi should be considered in immunosuppressed patients from these endemic areas and can be treated by surgical excision with or without coadjunctive antifungals (Los-Arcos et al. 2019).

EDV, caused by β-type human papilloma virus, can result in a generalized eruption of flat topped warts and areas of cutaneous change that can resemble tinea versicolor in morphology. Acquired EDV has been reported in persons with HIV/AIDS and recipients of solid organ transplants (Rogers et al. 2009; Ovits et al. 2017). In acquired EDV, it is hypothesized that depressed cell-mediated immunity results in increased susceptibility to otherwise nonpathogenic β-type human papilloma virus types (Rogers et al. 2009). Acquired EDV can be treated by de-escalating immunosuppressive therapy.

Left image: Phaeohyphomycosis. Smooth, multilobulated, pink nodule.

Center image: Epidermodysplasia verruciformis. Hypopigmented macules and flat-topped thin papules with overlying fine scale. Note the linear array on lesions on the scalp, consistent with the Koebner phenomenon. The patient gave his consent for photography and publication.

Right image: Histology of epidermodysplasia verruciformis. Keratinocytes with pale blue cytoplasm, multiple keratohyaline granules, and a thickened granular layer (×20 magnification).

Back to top
PreviousNext

In this issue

Clinical Journal of the American Society of Nephrology: 15 (6)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 6
June 08, 2020
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
Sign up for alerts
View Selected Citations (0)

Jump to

  • Patient Voice
  • Editorials
  • Original Articles
    • Chronic Kidney Disease
    • Maintenance Dialysis
    • Transplantation
  • Research Letter
  • Genomics of Kidney Disease
  • Kidney Case Conference: Nephrology Quiz and Questionnaire
  • Perspectives
  • Features
  • Most Read
Loading
  • Revisiting Filtration Fraction as an Index of the Risk of Hemofilter Clotting in Continuous Venovenous Hemofiltration
  • COVID-19 in Patients with Kidney Disease
  • COVID-19 and the Inpatient Dialysis Unit
  • How COVID-19 Has Changed the Management of Glomerular Diseases
  • Mitigating Risk of COVID-19 in Dialysis Facilities
More...

Articles

  • Current Issue
  • Early Access
  • Subject Collections
  • Article Archive
  • ASN Meeting Abstracts

Information for Authors

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • ASN Journal Policies
  • Reuse/Reprint Policy

About

  • CJASN
  • ASN
  • ASN Journals
  • ASN Kidney News

Journal Information

  • About CJASN
  • CJASN Email Alerts
  • CJASN Key Impact Information
  • CJASN Podcasts
  • CJASN RSS Feeds
  • Editorial Board

More Information

  • Advertise
  • ASN Podcasts
  • ASN Publications
  • Become an ASN Member
  • Feedback
  • Follow on Twitter
  • Password/Email Address Changes
  • Subscribe to ASN Journals

© 2021 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire