Martin Iurilli, L Guarini, Stefano Di Bella, Verena Zerbato, Giovanni PAPA
BACKGROUND: Cutaneous Scedosporium infection represents an extremely rare opportunistic fungal complication in solid-organ transplant recipients, often mimicking post-transplant skin malignancies due to chronic immunosuppression. CASE PRESENTATION: A 75-year-old woman, kidney transplanted in 2022 for IgA nephropathy on tacrolimus, mycophenolate, and prednisone, developed progressive firm nodular lesions on the left lower limb over two months. Punch biopsy revealed granulomatous inflammation with septate hyphae on Gomori-Grocott stain; culture confirmed Scedosporium spp. CT excluded dissemination. CONCLUSION: Voriconazole (6 mg/kg loading dose, then 4 mg/kg maintenance dose) combined with surgical debridement, negative-pressure wound therapy, and skin grafting achieved complete healing at three months, with no recurrence at 12 months. Early biopsy is crucial to differentiate this rare entity from squamous cell carcinoma, enabling multidisciplinary success.