Abstract
Clinical manifestations, treatment, and outcomes of cutaneous cryptococcosis in solid organ transplant (SOT) recipients are not fully defined. In a prospective cohort comprising 146 SOT recipients with cryptococcosis, we describe the presentation, antifungal therapy, and outcome of cutaneous cryptococcal disease. Cutaneous cryptococcosis was documented in 26/146 (17.8%) of the patients and manifested as nodular/mass (34.8%), maculopapule (30.4%), ulcer/pustule/abscess (30.4%), and cellulitis (30.4%) with 65.2% of the skin lesions occurred in the lower extremities. Localized disease developed in 30.8% (8/26), and disseminated disease in 69.2% (18/26) with involvement of the central nervous system (88.9%, 16/18), lung (33.3%, 6/18), or fungemia (55.6%, 10/18). Fluconazole (37.5%) was employed most often for localized and lipid formulations of amphotericin B (61.1%) for disseminated disease. Overall mortality at 90 days was 15.4% (4/26) with 16.7% in disseminated and 12.5% in localized disease (P = 0.78). SOT recipients who died were more likely to have renal failure (75.0% vs. 13.6%, P = 0.028), longer time to onset of disease after transplantation (87.5 vs. 22.6 months, P = 0.023), and abnormal mental status (75% vs. 13.6%, P = 0.028) than those who survived. Cutaneous cryptococcosis represents disseminated disease in most SOT recipients and preferentially involves the extremities. Outcomes with appropriate management were comparable between SOT recipients with localized and disseminated cryptococcosis.
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Acknowledgements
Funding sources: National Institutes of Health, National Institute of Allergy and Infectious Diseases (R01 AI 054719-01 to Nina Singh).
Declarations of interest: Barbara D. Alexander has served on advisory boards for Enzon, Basilea, Abbott, and Schering-Plough, served on speaker's bureaus of Astellas and Pfizer, and received grants from Astellas, Enzon, and Pfizer; Graeme Forrest has received a grant from Astellas. G. Marshall Lyon has served on advisory boards for and received grants from Merck and Astellas, and on speaker's bureaus of Astellas, Schering-Plough, and Wyeth; Kenneth Pursell has served on a speaker's bureau of Merck; Michele I. Morris has served on advisory boards for Astellas, Pfizer, and Merck, has received grants from Astellas, Basilea, and Pfizer, and has served on speaker's bureaus of Astellas and Pfizer; Patricia Munoz has served on speaker's bureaus of Merck and Novartis and on an advisory board for Pfizer; Sally H. Houston has served on speaker's bureaus of Astellas and Pfizer; Leonard B. Johnson has served on a speaker's bureau of Pfizer; Shahid Husain has served on consultant boards for and received grants from Pfizer, Astellas, and Schering-Plough; Nina Singh has received a grant from Pfizer; other authors have no conflicts.
This paper was first published online on Early Online on 25 January 2010.