Patient-identified health service transformation: an Aboriginal patient’s experience with extensive chronic tinea corporis and delayed kidney transplantation wait-listing

Extensive chronic tinea corporis (EC-TC) is common in people living in tropical environments and in individuals living with diabetes and chronic kidney disease (CKD). However, adults with end-stage kidney disease (ESKD) who seek kidney transplant (KTx) wait-listing require an infection-free medical clearance. Australian clinical care guidelines suggest tinea corporis is cured by antifungal treatment within 2 weeks in the general population, but there are no specific treatment guidelines for adults with severely reduced kidney function who require haemodialysis. Aim To describe factors contributing to delayed KTx wait-listing in a patient with EC-TC. Method: We undertook a case review to address both treatment response for EC-TC for a 43-year-old female with a history of diabetic nephropathy following haemodialysis initiation, and the time it took for her to achieve KTx wait-listing. Follow-up interviews with the client and supporting clinicians were completed in order to learn more about individual perspectives of care. Results We observed cure of EC-TC on day 394, and achievement of KTx wait-listing on day 496. The treatment algorithm used to achieve cure involved extended courses of oral terbinafine (250 mg post-dialysis three times weekly, partial response) and oral fluconazole (cure within 3 weeks; 100 mg weekly at dialysis). Holistic care during KTx workup was valued by the patient. Conclusion Delayed cure of EC-TC contributed to delayed KTx wait-listing. The in-depth interviews therefore identified healthcare innovations to assist systematic identification and treatment initiation for EC-TC. Furthermore, specific research to improve the treatment response is recommended.