Department of Dermatology, Edouard-Herriot Hospital Group, Lyon, France.
Eur J Dermatol. 2012 Sep-Oct;22(5):651-7. doi: 10.1684/ejd.2012.1819.
Data on post-graft cutaneous cryptococcosis (CC) are rare. The objective was to delineate the epidemiological, clinical, diagnostic, therapeutic features of CC in organ transplant recipients. We compared cases from a cohort of 3,670 transplanted adults with cases from a regional cryptococcosis registry including 122 patients. Four CC were diagnosed in the transplanted cohort (1‰) corresponding in the regional registry to 33% of the 12 cases of cryptococcosis after transplantation, while among the 110 non-grafted patients, only five cryptococcosis were cutaneous (4%). CC appeared as a single (3 patients) ulcer or nodule over 1cm in size in an uncovered body zone, on average 13 months post-graft. 3 patients had concomitant opportunistic infections or a recent increase in their immunosuppression. All CC after transplantation were localized exclusively to the skin, raising the question of the mode of contamination (through the skin or the lungs). Evidence of dissemination is difficult because of the poor sensitivity of diagnostic tests. Fluconazole was the treatment of choice in association with immunosuppressive treatment tapering.
皮肤移植后 cryptococcosis (CC) 的数据很少。目的是描述器官移植受者中 CC 的流行病学、临床、诊断和治疗特征。我们比较了 3670 名成年移植患者队列中的病例和包括 122 名患者的区域 cryptococcosis 登记处的病例。在移植队列中诊断出 4 例 CC（1‰），而在区域登记处，移植后 cryptococcosis 的 12 例中有 33%是 CC，而在 110 名非移植患者中，只有 5 例 cryptococcosis 是皮肤（4%）。CC 表现为单个（3 例）溃疡或直径超过 1cm 的结节，位于未覆盖的身体区域，平均在移植后 13 个月。3 例患者同时存在机会性感染或最近增加了免疫抑制治疗。所有移植后的 CC 均局限于皮肤，这引发了关于污染途径（通过皮肤或肺部）的问题。由于诊断试验的敏感性差，很难发现播散的证据。氟康唑联合免疫抑制治疗逐渐减少是治疗的首选。
