title: Cutaneous cryptococcosis in solid organ transplant recipients.
abstract: Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid organ transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SOT recipients who died were more likely to have renal failure (75.0% vs. 13.6%, P = 0.028), longer time to onset of disease after transplantation (87.5 vs. 22.6 months, P = 0.023), and abnormal mental status (75% vs. 13.6%, P = 0.028) than those who survived. Cutaneous cryptococcosis represents disseminated disease in most SOT recipients and preferentially involves the extremities. Outcomes with appropriate management were comparable between SOT recipients with localized and disseminated cryptococcosis.
authors.affiliation: VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Francoise
authors.initials: F
authors.lastname: Dromer
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: Ramon
authors.initials: R
authors.lastname: Del Busto
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Sally H
authors.initials: SH
authors.lastname: Houston
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D020314:Central Nervous System Fungal Infections / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D003453:Cryptococcosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D003881:Dermatomycoses / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014180:Transplantation; D019737:Transplants / Q000009:adverse effects*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole