Haridasan Satish, Parameswaran Sreejith, Bheemanathi Srinivas Hanuman, Chandrasekhar Laxmisha, Suseela Bibilash Babu, Singh Rakesh, Rabindranath Jayasurya, Padhi Rajesh Kumar, Sampath Ezhilnilavan, Dubey Avinash Kumar, Puthenpurackal Priyamvada Sivan Pillai
Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Pathology, JIPMER, Puducherry, India.
Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12788. Epub 2017 Nov 27.
Superficial and deep fungal infections are more frequent in transplant recipients primarily because of the failure of cell-mediated immunity and lesser amount of antigen-presenting Langerhans cells in their epidermis. Here, we report seven cases of post-renal transplant subcutaneous phaeohyphomycosis, all of which manifested within 1 year after transplantation and were unresponsive to prolonged courses of itraconazole. This is the first case series, to our knowledge, of phaeohyphomycosis in transplant recipients in India.
We performed a retrospective review of cases of phaeohyphomycosis among kidney transplant recipients for type of transplant, immunosuppression, histopathology, and treatment, with prospective follow-up of healed lesion.
An overall incidence of 8.3% was noted, with a median duration of approximately 6 months post transplant to the onset of skin lesion. None of the lesions responded to itraconazole alone and 6/7 lesions were surgically excised. Histopathology showed various lesions and culture could isolate Neocytalidium and Exophiala jeanselmi in two cases.
Dematiaceous fungi are increasingly implicated in cutaneous lesions in transplant recipients. Histopathology and surgical excision are the appropriate tools for diagnosis and treatment, respectively.
浅表和深部真菌感染在移植受者中更为常见，主要是因为细胞介导的免疫功能衰竭以及其表皮中抗原呈递朗格汉斯细胞数量较少。在此，我们报告7例肾移植术后皮下暗色丝孢霉病病例，所有病例均在移植后1年内出现，且对长期使用伊曲康唑治疗无反应。据我们所知，这是印度首例关于移植受者暗色丝孢霉病的病例系列报道。
我们对肾移植受者中暗色丝孢霉病病例进行了回顾性分析，内容包括移植类型、免疫抑制情况、组织病理学和治疗方法，并对愈合病变进行了前瞻性随访。
总体发病率为8.3%，从移植到皮肤病变出现的中位时间约为6个月。所有病变单独使用伊曲康唑均无反应，7例病变中有6例接受了手术切除。组织病理学显示了各种病变，培养在2例中分离出了新瓶霉属和甄氏外瓶霉。
暗色真菌越来越多地与移植受者的皮肤病变有关。组织病理学和手术切除分别是诊断和治疗的合适手段。
