Claire Rouzaud1, Olivier Chosidow2, Anabelle Brocard3, Sylvie Fraitag4, Anne Scemla5, Dany Anglicheau6, Jean-David Bouaziz7, Nicolas Dupin8, Marie-Elisabeth Bougnoux9, Roderick Hay10, Olivier Lortholary1,11, Fanny Lanternier1,11. 1. Infectious Diseases and Tropical Medicine Department, Necker-Pasteur Infectious Diseases Center, Necker-Enfants malades Hospital, AP-HP, IHU Imagine, Paris Descartes University, Paris, France. 2. Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil University, Créteil, France. 3. Department of Dermatology, Nantes University Hospital, Nantes, France. 4. Department of Pathology, Necker-Enfants malades Hospital, AP-HP, Paris Descartes University, Paris, France. 5. Department of Nephrology-Transplantation, Necker-Enfants malades Hospital, AP-HP, Paris Descartes Sorbonne Paris Cité University, RTRS Centaure, Labex Transplantex, Paris, France. 6. Paris Descartes University, Department of Nephrology-Transplantation, Necker-Enfants malades Hospital, AP-HP, Paris, France. 7. Department of Dermatology, Saint Louis Hospital, AP-HP, Paris, France. 8. Department of Dermatology, Cochin Tarnier Hospital, AP-HP, Paris Descartes University, Paris, France. 9. Department of Mycology, Necker-Enfants malades Hospital, AP-HP, Paris Descartes University, Paris, France. 10. Dermatology Department, King's College Hospital NHS Trust, London, UK. 11. National Reference Center for Invasive Mycoses and Antifungals Molecular Mycology Unit, CNRS URA3012, Institut Pasteur, Paris, France.
Abstract
OBJECTIVE: Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD: The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS: A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION: Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
OBJECTIVE: Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD: The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS: A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION: Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
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