Phaeohyphomycosis due to Nigrograna chromolaenae in a cardiac transplant patient

Nigrograna spp. have been reported as an emerging cause of black grain eumycetoma in immunocompromised patients. We report a unique case of Nigrograna chromolaenae, a plant pathogen previously unreported as a cause of cutaneous infection in a human host. A 71-year-old male with prior history of cardiac transplant and multiple comorbidities presented with a nodular hand lesion with continued progression. After initial antifungal agents were unsuccessful, the addition of posaconazole resulted in improvement of symptoms.