title: Cutaneous cryptococcosis in solid organ transplant recipients: epidemiological, clinical, diagnostic and therapeutic features.
abstract: Data on post-graft cutaneous cryptococcosis (CC) are rare. The objective was to delineate the epidemiological, clinical, diagnostic, therapeutic features of CC in organ transplant recipients. We compared cases from a cohort of 3,670 transplanted adults with cases from a regional cryptococcosis registry including 122 patients. Four CC were diagnosed in the transplanted cohort (1‰) corresponding in the regional registry to 33% of the 12 cases of cryptococcosis after transplantation, while among the 110 non-grafted patients, only five cryptococcosis were cutaneous (4%). CC appeared as a single (3 patients) ulcer or nodule over 1cm in size in an uncovered body zone, on average 13 months post-graft. 3 patients had concomitant opportunistic infections or a recent increase in their immunosuppression. All CC after transplantation were localized exclusively to the skin, raising the question of the mode of contamination (through the skin or the lungs). Evidence of dissemination is difficult because of the poor sensitivity of diagnostic tests. Fluconazole was the treatment of choice in association with immunosuppressive treatment tapering.
authors.affiliation: Department of Dermatology, Edouard-Herriot Hospital Group, Lyon, France. doriane.biancheri@gmail.com
authors.forename: Doriane
authors.initials: D
authors.lastname: Biancheri
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Bienvenu
authors.forename: Stephane
authors.initials: S
authors.lastname: Picot
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Michel
authors.initials: M
authors.lastname: Faure
authors.forename: Sylvie
authors.initials: S
authors.lastname: Euvrard
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D003881:Dermatomycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D015725:Fluconazole