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Abstract

Coelomycetes, including Microsphaerulopsis arundinis and Paraconiothyrium cyclothyrioides, are rare fungi increasingly implicated in opportunistic infections among immunocompromised patients. We report a 22-year-old heart transplant recipient who developed an enlarging erythematous plaque on the right knee after minor trauma with soil exposure, refractory to multiple treatments. Histology revealed suppurative granulomatous inflammation with septate hyphae; cultures grew mold, but species identification was inconclusive. Matrix assisted laser desorption/ionization (MALDI-TOF) analysis and 16S ribosomal DNA analysis with reflex next-generation sequencing (16S rDNA/reflex NGS) identified coelomycetous fungi. Antifungal susceptibility testing prompted a change in therapy and clinical improvement. This case illustrates the diagnostic and therapeutic challenges posed by uncommon fungal infections in immunosuppressed hosts and emphasizes the role of molecular diagnostics when conventional methods are insufficient.