Original article
Deep cutaneous fungal infections in solid-organ transplant recipients

https://doi.org/10.1016/j.jaad.2019.12.064Get rights and content

Background

Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs).

Objective

To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs.

Methods

A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed.

Results

Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs.

Limitations

Due to the retrospective observational design of the study.

Conclusions

Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.

Section snippets

Patients and methods

Epidemiologic, clinical, fungal, and transplant parameters were retrospectively collected in s-OTRs with a diagnosis of DCFI in centers belonging to the Skin and Organ Transplantation Group of the French Society of Dermatology.

s-OTR adult patients were included if they had a proven diagnosis of invasive fungal infection, as defined by European Organization for Research and Treatment of Cancer–Mycoses Study Group.6 DCFI was defined as a dermal fungal infection, including systemic fungal

Demographic and transplant data

Forty-six patients who received diagnoses from 1998 through 2016 from 8 centers were included in the study. The median age at diagnosis was 56.5 years (range, 16-72 years), with a male-to-female sex ratio of 2.54. Forty-eight percent of patients originated from Europe. Characteristics of s-OTRs with DCFIs are reported in Table I. Median and mean delays between transplant and diagnosis of DCFI were, respectively, 13.4 and 28 months (range, 2-144 months). Patients received transplants at a mean

Discussion

This multicenter observational study has highlighted a large diversity of DCFIs in s-OTRs in France. Primary DCFI in s-OTRs occurred mostly in the first 2 years after transplant, which is in line with a previous series of 22 s-OTR patients in Italy, to our knowledge the only previous series reported in Europe.13 In that case-control, multicenter, cohort, retrospective study, risk factors reported for DCFI were the first 2-year period after transplant, being a kidney transplant recipient, and

Conclusion

This observational study has highlighted the large diversity of DCFIs observed in s-OTRs, with the highest prevalence found for phaeohyphomycoses. Nodular lesions on lower limbs and granulomatous findings on histopathology were helpful diagnostic clues. Appropriate therapeutic management by a multidisciplinary team of dermatologists, transplant specialists, pathologists, and mycologists, based on specific, mostly systemic, antifungal treatment; surgery; and IS modulation, is required to obtain

References (17)

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Funding sources: Supported by Skin and Organ Transplantation Group of the French Society of Dermatology (Groupe Peau et Greffe d'organe de la Société Française de Dermatologie).

Disclosure: Dr Lebbé received research grants or honoraria from Roche, Bristol-Myers Squibb, Merck Sharpe & Dohme, GlaxoSmithKline, Novartis, and Amgen outside the submitted work. Drs Galezowski, Delyon, Le Cleach, Guégan, Ducroux, Alanio, Lastennet, Moguilet, Dadban, Leccia, Pelletier, Francès, and Barete have no conflicts of interest to declare.

IRB approval status: Informed consent in accordance with the Declaration of Helsinki.

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© 2020 by the American Academy of Dermatology, Inc.