Cutaneous cryptococcosis in solid organ transplant recipients.
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.
Sun
Hsin-Yun
HY
VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
Alexander
Barbara D
BD
Lortholary
Olivier
O
Dromer
Francoise
F
Forrest
Graeme N
GN
Lyon
G Marshall
GM
Somani
Jyoti
J
Gupta
Krishan L
KL
Del Busto
Ramon
R
Pruett
Timothy L
TL
Sifri
Costi D
CD
Limaye
Ajit P
AP
John
George T
GT
Klintmalm
Goran B
GB
Pursell
Kenneth
K
Stosor
Valentina
V
Morris
Michele I
MI
Dowdy
Lorraine A
LA
Muñoz
Patricia
P
Kalil
Andre C
AC
Garcia-Diaz
Julia
J
Orloff
Susan L
SL
House
Andrew A
AA
Houston
Sally H
SH
Wray
Dannah
D
Huprikar
Shirish
S
Johnson
Leonard B
LB
Humar
Atul
A
Razonable
Raymund R
RR
Fisher
Robert A
RA
Husain
Shahid
S
Wagener
Marilyn M
MM
Singh
Nina
N
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*
D000935:Antifungal Agents; D015725:Fluconazole