Wolfson J S, Sober A J, Rubin R H
Medicine (Baltimore). 1985 Mar;64(2):115-33. doi: 10.1097/00005792-198503000-00004.
Thirty-one immunocompromised patients (22 renal allograft recipients, 5 patients receiving chronic corticosteroid therapy, and 4 patients undergoing chemotherapy for acute leukemia) with significant dermatologic infection, excluding typical cellulitis and herpesvirus infections, were retrospectively identified over a 12-year period. Of these 31 patients, 15 (48%) had infection restricted to their skin, 6 (19%) appeared to have primary cutaneous infection that spread hematogenously to other parts of the body, 2 (6%) had infections of adjoining nasal tissue that spread to contiguous skin, and 8 (26%) appeared to have disseminated systemic infection that spread to the skin. In six of the eight patients with apparent secondary skin involvement, the development of the cutaneous lesion was the first clinical indication of disseminated infection. Eleven immunocompromised patients (35%) with bacterial infection of the skin or subcutaneous tissue were identified. These patients could be divided into three categories: leukemic patients with bacteremic gram-negative infection metastasizing to the skin (3 cases), renal transplant recipients with recurrent staphylococcal infection on and around the elbow ("transplant elbow") or streptococcal sepsis from a site of cellulitis (5 cases), and immunocompromised patients with opportunistic bacterial infection due to Nocardia asteroides or atypical mycobacteria (3 cases). Seventeen immunocompromised patients (55%) with fungal infection of the skin or subcutaneous tissue were identified. These included 12 patients with opportunistic fungal infection (Cryptococcus neoformans, 4 cases; Aspergillus species, 3 cases; Paecilomyces, 2 cases; Rhizopus species, 2 cases; and Candida tropicalis, 1 case) and 5 patients with extensive, confluent cutaneous dermatophyte infections. One patient with protothecosis and two patients with extensive papillomavirus infection were identified. Of these latter two cases, one had his immunosuppression discontinued, with clearing of his extensive warts; the other had confluent warts of the face and neck that subsequently underwent malignant degeneration to squamous cell carcinoma while chronic immunosuppressive therapy was continued.(ABSTRACT TRUNCATED AT 400 WORDS)
在12年期间，对31例免疫功能低下且患有严重皮肤感染（不包括典型蜂窝织炎和疱疹病毒感染）的患者进行了回顾性研究，这些患者包括22例肾移植受者、5例接受慢性皮质类固醇治疗的患者以及4例因急性白血病接受化疗的患者。在这31例患者中，15例（48%）感染局限于皮肤，6例（19%）似乎为原发性皮肤感染并经血行播散至身体其他部位，2例（6%）感染相邻鼻组织并蔓延至邻近皮肤，8例（26%）似乎为播散性全身感染并蔓延至皮肤。在8例明显继发皮肤受累的患者中，有6例皮肤病变的出现是播散性感染的首个临床指征。确定了11例免疫功能低下且皮肤或皮下组织发生细菌感染的患者（35%）。这些患者可分为三类：白血病患者，其菌血症性革兰阴性菌感染转移至皮肤（3例）；肾移植受者，肘部及周围反复出现葡萄球菌感染（“移植肘”）或蜂窝织炎部位发生链球菌败血症（5例）；免疫功能低下患者，因星形诺卡菌或非典型分枝杆菌发生机会性细菌感染（3例）。确定了17例免疫功能低下且皮肤或皮下组织发生真菌感染的患者（55%）。其中包括12例机会性真菌感染患者（新型隐球菌4例；曲霉菌3例；拟青霉2例；根霉菌2例；热带念珠菌1例）以及5例广泛融合的皮肤癣菌感染患者。确定了1例原虫病患者和2例广泛乳头瘤病毒感染患者。在后两例中，1例停止免疫抑制治疗后，广泛疣消退；另1例面部和颈部融合性疣在继续进行慢性免疫抑制治疗时随后恶变为鳞状细胞癌。（摘要截短至400字）
