Primary Cutaneous Fungal Infection after Solid-Organ Transplantation: Report of Five Cases and Review

Abstract

Solid-organ transplant recipients who are receiving immunosuppressive therapy are at increased risk of acquiring opportunistic infections, particularly fungal infections. We present the cases of five liver transplant recipients who developed primary cutaneous opportunistic fungal infections that remained localized to the skin. These cases are compared with 27 previously reported cases of primary cutaneous fungal infections. In these previously reported cases, administration of systemic antifungal medications, including amphotericin B, ketoconazole, griseofulvin, and miconazole, resulted in a 71% survival rate. Medical and surgical therapy together resulted in an 86% survival rate, and surgical excision resulted in a 100% survival rate. Thus, regardless of the age of the patient, type of immunosuppressive therapy, clinical presentation, or organisms involved, surgical excision yielded the highest cure rate. When possible, surgical excision should be performed on solid-organ transplant recipients who acquire opportunistic fungal infections.

Primary cutaneous aspergillosis in an immunocompetent patient

“…Making an early diagnosis of PCA, especially in an immunocompetent patient is a clinical challenge, however, a combination of appropriate treatment with new antifungal drugs and careful considerations of adjunctive surgical therapy should improve the outcome in such patients. [910] This is aptly illuminated in our patient.…”

“…Treatment of primary cutaneous fungal infection is controversial, both medical and surgical modalities have been undertaken. [10] However, in the cutaneous disease, surgical excision alone and in some cases in combination with drug therapy has been found to be curative. [359–11] In our patients due to the extent of the lesions, a combination of drug therapy (Itraconazole), surgical excision, and rhomboid flap cover in the axillae was probably the only viable treatment option.…”

Majocchi’s Granuloma (Dermatophytic Granuloma): Updated Therapeutic Options

“…Surgical excision is recommended as a treatment for deep fungal infections in primary-origin immunosuppressed patients, although it is often recommended to combine surgical therapy with systemic antifungals [74]. Cryotherapy is also an alternative in recalcitrant cases [75].…”

Acremonium mycetoma in a heart transplant recipient

“…Abundant reports of subcutaneous fungal abscesses, 44 nodules, 45 ulcers, 46 phaeohyphomycotic soft-tissue infections, 7,8,47 and ''mycetoma-like'' lesions (defined as subcutaneous abscesses without draining sinus tracts but with grains noted on biopsy of the lesions) 9,41,48,49 have appeared in the literature; reports of true mycetomas, however, are rare. Only four cases of mycetoma have been described in solid organ transplant recipients (Table I).…”