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European Journal of Dermatology

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Cutaneous cryptococcosis in solid organ transplant recipients: epidemiological, clinical, diagnostic and therapeutic features Volume 22, issue 5, September-October 2012

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Authors
Department of Dermatology, Edouard-Herriot Hospital Group, Lyon, France, Malaria and Medical Mycology, Hospices Civils de Lyon, UMR5246, CNRS, University Lyon 1, 69004 Lyon, France, Department of Transplantation, Nephrology and Clinical Immunology, Edouard-Herriot Hospital Group, 5 place d’Arsonval, 69437 Lyon cedex 03, France

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.