Primary Cutaneous Cryptococcosis in aPatient  with Systemic Immunosuppression after Liver Transplantation

Hunger, Robert E.; Paredes, B.E.; Quattroppani, C.; Krähenbühl, Stephan; Braathen, Lasse R.

doi:10.1159/000018409

Cited by 24 publications

(10 citation statements)

References 13 publications

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“…A total of 59 cases in the literature in whom outcome at a median follow-up of 12 months was reported, were evaluable for the risk of relapse ( 15,(20)(21)(22)26,29,33,35,37,(40)(41)(42)(43)49,(52)(53)(54)58,(61)(62)(63). Relapse after cessation of therapy occurred in 18% (11/59).…”

Section: Treatment Regimens In Cases In the Literaturementioning

confidence: 99%

Antifungal Management Practices and Evolution of Infection in Organ Transplant Recipients with Cryptococcus Neoformans Infection

et al. 2005

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Section: Treatment Regimens In Cases In the Literaturementioning

confidence: 99%

Antifungal Management Practices and Evolution of Infection in Organ Transplant Recipients with Cryptococcus Neoformans Infection

et al. 2005

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“…Cutaneous infections with Cryptococcus neoformans have proteiform clinical manifestations with unique or multiple papular, ulcerative, or nodular lesions67, 68 They can even mimic bacterial cellulitis 69. Calcineurin‐inhibitors such as tacrolimus inhibit fungal calcineurin and have in vitro activity against C. neoformans 70, 71.…”

Section: Mucocutaneous Complications After Liver Transplantationmentioning

confidence: 99%

Nontumoral dermatologic problems after liver transplantation

2004

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The skin, easily accessible for medical examination, is affected in many ways by liver transplantation. Mucocutaneous manifestations of advanced liver disease and dermatologic conditions associated with specific hepatic diagnoses generally improve after liver transplantation. W ith the advent of new immunosuppressive medications and innovative surgical approaches, liver transplantation has become an attractive therapeutic option for liver failure secondary to numerous etiologies. More than 50,000 patients have benefited from liver transplantation worldwide, with an actuarial survival at 5 years above 70%. The resolution of dermatologic conditions such as pruritus participates in the dramatic improvement of the quality of life following liver transplantation. As the survival of these transplanted patients improves, secondary complications such as mucocutaneous pathologies arise. They range from benign conditions to life-threatening diseases. This review addresses the evolution after transplantation of dermatologic conditions related to the underlying liver disease as well as the recognition and treatment of skin diseases appearing specifically after liver transplantation. Skin cancers after liver transplantation will not be considered, as this topic has been previously well documented. [1][2][3][4] In contrast, to our knowledge, there are only two reported series regarding nontumoral dermatologic complications after liver transplantation, 5,6 and most of the published information in this area is in the form of case reports.

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“…11 Histoplasmosis and cryptococcal infections are routinely seen in immunosuppressed patients and can cause invasive cutaneous infections. [12][13][14] Although infection with Candida, Aspergillus, and Trichophyton can be seen in all patients, their disease course in immunosuppressed patients can be considerably more invasive even when cutaneous or on mucous membranes. [15][16][17][18] Patients on long-term steroid therapy have also presented with rare manifestations of disease, including cutaneous chromomycosis and whole-body cutaneous sporotrichosis.…”

Section: Discussionmentioning

confidence: 99%

Rare Lower Extremity Invasive Fungal Infection in an Immunosuppressed Patient: Exserohilum longirostratum

Al-Attar

Williams²,

Redett³

2006

Plastic and Reconstructive Surgery

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A 68-year-old immunosuppressed man presented with multiple ulcers and cellulitis on his right lower extremity. The patient was in good health until 6 months before admission, when routine screening revealed idiopathic thrombocytopenia with splenomegaly. The idiopathic thrombocytopenia was immediately treated with systemic steroids. After initiation of steroid therapy, the patient developed multiple ulcers circumferentially on his right lower extremity that later became cellulitic. Initiation of systemic steroid therapy in this patient was also complicated by diabetes mellitus and activation of chronic hepatitis C that contributed to cirrhosis and hepatic encephalopathy. At the time of examination, the patient was being evaluated for liver transplantation, and was assessed as Child's class B with a MELD score of 17.At the time of consultation for his lower extremity wounds, the patient's medications included oral prednisone. He was being treated with systemic voriconazole and Flagyl for a presumed polymicrobial infection of his lower extremity ulcers that had previously been unresponsive to systemic ciprofloxacin and gatifloxacin.Lower extremity examination revealed multiple well-demarcated ulcers on his right anterior and lateral lower leg (Fig. 1). The ulcers were dry and escharous and ranged in maximal diameter from 1 to 4 cm. Erythema surrounded the ulcers but without clear demarcation. Neither leg was excessively warm to touch. Neither purulence nor odor was noted. Dorsalis pedis and posterior tibial pulses were palpable bilaterally. Moderate edema was present bilaterally, and there was minimal brownish discoloration over both anterior tibial regions. The patient did not exhibit any sensory or motor deficits in his lower extremities, although movement resulted in lower extremity pain.Laboratory studies revealed severe thrombocytopenia and anemia with a mildly elevated white blood cell count. Tests for autoimmune markers including erythrocyte sedimentation rate, perinuclear antineutrophil cytoplasmic antibody, cytoplasmic antineutrophil cytoplasmic antibody, and cryoglobulins in the patient's serum were negative.Lower extremity computed tomographic scans did not find any evidence of fluid collections, subcutaneous gas, bony destruction, or periosteal reaction but did show moderate subcutaneous edema. Diagnostic skin biopsy specimens of the lower extremity ulcers and surrounding regions demonstrated diseased vasculature with thrombi in vessels along with focal necrosis, interstitial inflammation, and microabscesses. Microscopic examination also revealed multiple fungal elements. Biopsy cultures grew Escherichia coli, methicillin-resistant Staphylococcus aureus, and heavy fungal elements on all plates. The fungus was speciated as Exserohilum longirostratum that was sensitive to voriconazole; no other fungi were isolated. During his hospital course, the patient's lower extremity infection progressed and developed worsening ulcerations despite treatment with systemic antifungal therapy and local oxychlorosene-base...

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Primary Cutaneous Cryptococcosis in aPatient with Systemic Immunosuppression after Liver Transplantation

Cited by 24 publications

References 13 publications

Antifungal Management Practices and Evolution of Infection in Organ Transplant Recipients with Cryptococcus Neoformans Infection

Antifungal Management Practices and Evolution of Infection in Organ Transplant Recipients with Cryptococcus Neoformans Infection

Nontumoral dermatologic problems after liver transplantation

Rare Lower Extremity Invasive Fungal Infection in an Immunosuppressed Patient: Exserohilum longirostratum

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