VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
Med Mycol. 2010 Sep;48(6):785-91. doi: 10.3109/13693780903496617.
Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid organ transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SOT recipients who died were more likely to have renal failure (75.0% vs. 13.6%, P = 0.028), longer time to onset of disease after transplantation (87.5 vs. 22.6 months, P = 0.023), and abnormal mental status (75% vs. 13.6%, P = 0.028) than those who survived. Cutaneous cryptococcosis represents disseminated disease in most SOT recipients and preferentially involves the extremities. Outcomes with appropriate management were comparable between SOT recipients with localized and disseminated cryptococcosis.
在一项包含 146 例接受过实体器官移植 (SOT) 的隐球菌病患者的前瞻性队列研究中，我们描述了皮肤隐球菌病的表现、抗真菌治疗和结局。146 例患者中有 26 例（17.8%）记录到皮肤隐球菌病，表现为结节/肿块（34.8%）、斑丘疹（30.4%）、溃疡/脓疱/脓肿（30.4%）和蜂窝织炎（30.4%），65.2%的皮肤病变发生在下肢。局限性疾病占 30.8%（8/26），播散性疾病占 69.2%（18/26），中枢神经系统（88.9%，16/18）、肺部（33.3%，6/18）或真菌血症（55.6%，10/18）受累。氟康唑（37.5%）最常用于局限性疾病，两性霉素 B 的脂质制剂（61.1%）最常用于播散性疾病。90 天总体死亡率为 15.4%（4/26），播散性疾病为 16.7%，局限性疾病为 12.5%（P=0.78）。死亡的 SOT 受者更有可能患有肾衰竭（75.0%比 13.6%，P=0.028）、移植后发病时间更长（87.5 比 22.6 个月，P=0.023）和异常精神状态（75%比 13.6%，P=0.028）。与生存者相比，皮肤隐球菌病在大多数 SOT 受者中代表播散性疾病，且优先累及四肢。经过适当治疗，SOT 受者局限性和播散性隐球菌病的结局相当。
