Clinicopathologic review of 19 patients with systemic candidiasis with skin lesions.
BACKGROUND
A diagnosis of systemic candidiasis is often delayed or missed owing to the absence of sensitive, specific, and timely diagnostic tools. Skin lesions are not common, but they can help to rapidly establish a diagnosis. We report on a 14-year experience of systemic candidiasis with skin lesions in our institution. We report the prevalence, clinical findings, histologic findings, etiologic Candida species, underlying conditions, treatment modalities, and outcomes of the cases and compare them with the previous reports.


METHODS
We reviewed the medical records and laboratory data of patients diagnosed with systemic candidiasis from June 1989 to September 2002 at Asan Medical Center, Seoul, Korea. We thoroughly reviewed the data on those patients with characteristic skin lesions. We included the cases in which Candida organisms were either shown or cultured from the skin. We also included the patients who had developed the characteristic rash at the onset of infection if there was no other possible explanation for the rash.


RESULTS
Of 53 documented systemic candidiasis cases, 19 (35.8%) had the characteristic skin lesions. Fifteen patients (78.9%) had hematologic problems and were neutropenic. The skin lesions were a maculopapular or nodular rash and plaques. In addition to the trunk and proximal extremities, the rash also involved the face and distal extremities. The rashes were mostly purpuric, not consistently associated with underlying thrombocytopenia but also associated with underlying vascular damage as a result of Candida organisms. The underlying vascular damage also caused intraepidermal necrotic and vesicular change. One case of transepidermal elimination of organisms was newly found. The most common causative species was Candida tropicalis in the 19 patients with skin lesions, in contrast with Candida albicans in a total of 53 patients. The mortality rate was 84.2%.


CONCLUSIONS
The prevalence of systemic candidiasis-associated skin lesions may be higher than previously reported. Dermatologists should be familiar with the clinical appearance of skin lesions and suspect this fatal infection when seeing neutropenic patients with a resistant fever and accompanying rash.
Bae
Gee Young
GY
Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Lee
Hae Woong
HW
Chang
Sung Eun
SE
Moon
Kee Chan
KC
Lee
Mi Woo
MW
Choi
Jee Ho
JH
Koh
Jai Kyoung
JK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005076:Exanthema / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009503:Neutropenia; D012189:Retrospective Studies