Black Menace in a Foot Cyst of a Renal Transplant Recipient

Black menace, here representing Cladophialophora bantiana , is an opportunistic dematiaceous fungus associated with infections in immunocompromised patients, including renal transplant recipients. This case report details a 65-year-old male farmer who developed a progressively enlarging cyst on the dorsum of his left foot 3 years postrenal transplantation. Initial treatment for suspected bacterial cellulitis with broad-spectrum antibiotics proved ineffective. A biopsy revealed dark, pigmented hyphae, leading to the diagnosis of phaeohyphomycosis due to C. bantiana . The patient responded favorably to oral voriconazole, resulting in complete resolution of the lesion at 6 months. This case highlights the importance of considering atypical fungal infections in immunocompromised patients with unresponsive skin lesions.