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Primary cutaneous fungal infections in solid organ transplantation: a case series
Abstract:
Cutaneous fungal infections in solid-organ transplant patients present in a variety of nonspecific ways, requiring a high index of suspicion to diagnose correctly. In the present series of four transplant recipients, subsequent primary cutaneous fungal infections presented as papules, plaques, ulcers and subcutaneous nodules. Transplantations included one cardiac, two renal and one renal-pancreatic transplant. Fungal infections were limited to the skin; there was no evidence of disseminated disease in any case. The pathogens isolated were Scedosporium apiospermum (Pseudallescheria boydii), Alternaria species, Aspergillus fumigatus, and a coelomycete in the Coniothyrium-Microsphaeropsis complex of dark molds. Individuals were successfully treated with surgical debridement, antifungal agents, and reduction of immunosuppressive therapy. All patients and allografts survived. Accurate diagnosis, aggressive surgery and appropriate antifungal therapy, combined with close outpatient follow-up, optimize the likelihood of a cure in a transplant population.
Insights
Cutaneous fungal infections in transplant patients can appear non-specific. Early diagnosis and a combination of surgery, antifungals, and reduced immunosuppression lead to successful outcomes.
Area of Science:
- Mycology
- Transplant Surgery
- Dermatology
Background:
- Solid-organ transplant recipients are susceptible to opportunistic infections.
- Cutaneous fungal infections in this population often present with nonspecific symptoms.
- A high index of suspicion is crucial for timely diagnosis.
Observation:
- Four transplant recipients (cardiac, renal, renal-pancreatic) developed primary cutaneous fungal infections.
- Lesions manifested as papules, plaques, ulcers, and subcutaneous nodules.
- Infections were confined to the skin, with no evidence of systemic spread.
Findings:
- Pathogens identified included Scedosporium apiospermum, Alternaria, Aspergillus fumigatus, and dark molds (Coniothyrium-Microsphaeropsis complex).
- Treatment involved surgical debridement, antifungal medications, and decreased immunosuppressive therapy.
- All patients and their transplanted organs survived the infections.
Implications:
- Prompt diagnosis and aggressive management are key for treating cutaneous fungal infections in transplant patients.
- Multimodal therapy including surgery, antifungals, and immunosuppression adjustment improves patient and graft survival.
- Close post-treatment follow-up is essential for optimizing cure rates.