Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2020-01-11 , DOI: 10.1016/j.jaad.2019.12.064 Agnès Galezowski 1 , Julie Delyon 2 , Laurence Le Cleach 3 , Sarah Guégan 4 , Emilie Ducroux 5 , Alexandre Alanio 6 , Diane Lastennet 7 , Philippe Moguelet 8 , Ali Dadban 9 , Marie Thérèse Leccia 10 , François Le Pelletier 11 , Camille Francès 12 , Céleste Lebbé 2 , Stéphane Barete 1 ,
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.
中文翻译:
实体器官移植受者的深层皮肤真菌感染。
背景
在免疫抑制的患者中深部皮肤真菌感染(DCFI)有所不同,在实体器官移植受者(s-OTRs)中此类感染的数据很少。
目的
确定s-OTR中DCFI的诊断特征和结果。
方法
在法国,对8个诊断为DCFIs的s-OTR的主要皮肤病专科中心进行了为期20年的回顾性观察研究。分析了有关移植,真菌种类,治疗和结果的相关临床数据。
结果
总体而言,有46例s-OTR发生了DCFIs(中位延迟,移植后13个月),伴有主要的疏脂性粘膜炎(46%)。四肢结节性病变的分布以及肉芽肿的组织病理学发现是有助于诊断的线索。接受的治疗包括全身性抗真菌治疗(48%),全身性抗真菌治疗与手术相结合(28%),仅手术(15%)和免疫抑制调节(61%),从而导致63%的s-OTR完全缓解。
局限性
由于研究的回顾性观察设计。
结论
疏水性霉菌病是s-OTR中最常见的DCFI。多学科团队有助于最佳诊断和管理。