Prakash J, Singh S, Prashant G K, Kar B, Tripathi K, Singh P B
Department of Nephrology, Institute of Medical Science, Banaras Hindu University, Varanasi, India.
Transplant Proc. 2004 Sep;36(7):2162-4. doi: 10.1016/j.transproceed.2004.08.011.
Dermatological manifestations are common in renal transplant patients, but differ markedly with ethnic group and geographical location. We studied mucocutaneous lesions in 54 renal allograft recipients (related donors = 30; unrelated donors = 24) living in tropical atmospheres. Their gender was 50 males, and 4 females ranging in age between 15 and 63 years (mean = 37.84 years). The mean duration of follow-up was 124 months (range = 4 to 173 months). All patients received kidneys from living donors and were kept on immunosupression with mean daily doses of prednisolone, azathioprine, and cyclosporine of 10.2 mg, 68.6 mg, and 252 mg, respectively. The mean trough concentration of cyclosporine was 185 ng/mL. The mucocutaneous lesions were divided into four groups: drug-induced (n = 24, 44.4%), fungal (n = 18, 33.3%), viral (n = 9, 16.6%), and bacterial (n = 10, 18.5%). Cushingoid features, gum hypertrophy, and hypertrichosis were seen in 7 (12.9%) patients. Steroid acne was seen in three cases. Pityriasis versicolor was the most common (20.3%) fungal infection of the skin. In addition, Tinea unguium and mucocutaneous candidiasis were noted in four and three cases respectively. Herpes virus infection (Herpes zoster 5; Herpes simplex 2) was noted in 7 (12.9%) cases. Chicken pox at 5 years posttransplant and cutaneous vasculitis associated with cytomegalovirus disease at 6 months posttransplant were seen in one case each. We have not seen warts in our patients. Pyogenic bacterial infection of skin in the form of abscess (n = 6), cellulitis (n = 3), and pyoderma (n = 1) were observed in 10 (18.5%) patients. Thus, drug-induced mucocutaneous side effects and skin fungal infections are the most common dermatological manifestations among renal transplant recipients living in a tropical country.
皮肤表现在肾移植患者中很常见，但因种族和地理位置的不同而有显著差异。我们研究了54名生活在热带地区的同种异体肾移植受者（亲属供体 = 30例；非亲属供体 = 24例）的黏膜皮肤病变。他们的性别为50名男性和4名女性，年龄在15至63岁之间（平均 = 37.84岁）。平均随访时间为124个月（范围 = 4至173个月）。所有患者均接受活体供肾，并接受免疫抑制治疗，泼尼松龙、硫唑嘌呤和环孢素的平均每日剂量分别为10.2 mg、68.6 mg和252 mg。环孢素的平均谷浓度为185 ng/mL。黏膜皮肤病变分为四组：药物性（n = 24，44.4%）、真菌性（n = 18，33.3%）、病毒性（n = 9，16.6%）和细菌性（n = 10，18.5%）。7名（12.9%）患者出现库欣样特征、牙龈增生和多毛症。3例出现类固醇性痤疮。花斑糠疹是最常见的（20.3%）皮肤真菌感染。此外，分别有4例和3例发现甲癣和黏膜皮肤念珠菌病。7名（12.9%）患者出现疱疹病毒感染（带状疱疹5例；单纯疱疹2例）。移植后5年出现水痘1例，移植后6个月出现与巨细胞病毒病相关的皮肤血管炎1例。我们的患者中未发现疣。10名（18.5%）患者出现以脓肿（n = 6）、蜂窝织炎（n = 3）和脓疱病（n = 1）形式的皮肤化脓性细菌感染。因此，药物性黏膜皮肤副作用和皮肤真菌感染是生活在热带国家的肾移植受者中最常见的皮肤表现。
