Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France.
J Am Acad Dermatol. 2020 Aug;83(2):455-462. doi: 10.1016/j.jaad.2019.12.064. Epub 2020 Jan 11.
Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs).
To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs.
A 20-year retrospective observational study in France was conducted in 8 primary dermatology-dedicated centers for s-OTRs diagnosed with DCFIs. Relevant clinical data on transplants, fungal species, treatments, and outcomes were analyzed.
Overall, 46 s-OTRs developed DCFIs (median delay, 13 months after transplant) with predominant phaeohyphomycoses (46%). Distribution of nodular lesions on limbs and granulomatous findings on histopathology were helpful diagnostic clues. Treatments received were systemic antifungal therapies (48%), systemic antifungal therapies combined with surgery (28%), surgery alone (15%), and modulation of immunosuppression (61%), leading to complete response in 63% of s-OTRs.
Due to the retrospective observational design of the study.
Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.
深部皮肤真菌感染（DCFI）在免疫抑制患者中多种多样，而实体器官移植受者（s-OTR）中此类感染的数据较少。
确定 s-OTR 中 DCFI 的诊断特征和治疗结果。
在法国的 8 个专门用于 s-OTR 的初级皮肤科中心进行了一项为期 20 年的回顾性观察研究，对诊断为 DCFI 的 s-OTR 进行了研究。分析了与移植、真菌种类、治疗和结果相关的临床数据。
总体而言，46 名 s-OTR 发生了 DCFI（移植后中位时间为 13 个月），其中以暗色丝孢霉病（46%）为主。肢体结节性病变和组织病理学上的肉芽肿性发现是有帮助的诊断线索。接受的治疗包括全身抗真菌治疗（48%）、全身抗真菌治疗联合手术（28%）、单独手术（15%）和免疫抑制调节（61%），导致 63%的 s-OTR 完全缓解。
由于研究的回顾性观察设计。
暗色丝孢霉病是 s-OTR 中最常见的 DCFI。多学科团队有助于进行最佳诊断和管理。
