Interesting case for discussion, heart transplant (Cardiology)

Doaa Aly Elsayed Mohamed Attia., MBBCH


Medical Case Details:

A heart transplant recipient, who is a 65-year-old female, presented to the transplant clinic. Her complaint is right index finger swelling that evolved 6 months after the transplant. Her immunosuppressive medications were Tacrolimus, CellCept, and Prednisone. The swelling was getting worse in the last month. There is no associated pain, tenderness or fever. There is no previous history of trauma.

On physical examination, 4 cm mass along the right middle metacarpophalangeal joint. There is no erythema, warmth, or tenderness. CT was performed and showed a multilobulated mass. What is the next step? What do you think that patient might have?



    Dr. Vivek Pillai

    It could be a possible soft tissue sarcoma given the patients history of immunosupressive therapy.

    17.Oct, 08:57pm

    Dr. Vinod Kumar Goyal
    Ayurveda Specialist

    Hi dear
    It appears to be side effect of medicines given.
    u can give-
    punarnavarishta 2-3 tsf daily bid for 2 months
    Patient will be alright

    18.Oct, 03:52pm

    Dr. Singh Smrita

    The best step would be to take a biopsy and get it evaluated by a Pathologist. That would give you a definite idea as to the nature of the mass and you could then decide the treatment plan accordingly.

    ▲ 1
    23.Oct, 05:12pm

    Dr. Doaa Aly Elsayed Mohamed Attia
    General Practitioner

    Thanks all for your replies. I think that Dr. Smrita is right. We referred the patient first to the orthopedic clinic because we suspected a giant cell tumor. Then, They took a biopsy. She started a broad vancomycin empirically. Surprisingly, that the specimen showed a very rare fungal infection(subcutaneous phaeohyphomycosis by Exhophiala). She was treated by voriconazole and surgical resection. She had a recurrence in another finger. But the surgeon recommended no more interventions and for her to take only voriconazole. She is now on follow up

    ▲ 1
    05.Nov, 12:03am

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