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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 19 février 2020
Doi : 10.1016/j.jaad.2019.12.064
accepted : 31 December 2019
Deep cutaneous fungal infections in solid-organ transplant recipients
 

Agnès Galezowski, MD a, Julie Delyon, MD, PhD b, Laurence Le Cleach, MD c, Sarah Guégan, MD, PhD d, Emilie Ducroux, MD e, Alexandre Alanio, MD, PhD f, g, Diane Lastennet, MD, PhD h, Philippe Moguelet, MD i, Ali Dadban, MD j, Marie Thérèse Leccia, MD, PhD k, François Le Pelletier, MD l, Camille Francès, MD m, Céleste Lebbé, MD, PhD b, Stéphane Barete, MD, PhD a,
on behalf of

Skin and Organ Transplantation Group of the French Society of Dermatology

a Unit of Dermatology, DMU3ID, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France 
b Department of Dermatology, Saint-Louis Hospital, AP-HP, Institut National de la Santé et de la Recherche Médicale U976, Université de Paris Paris, France 
c Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil Val de Marne–Paris 12 University, Créteil, France 
d Department of Dermatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France 
e Department of Dermatology, Edouard Herriot Hospital, Lyon, France 
f Department of Parasitology-Mycology, Saint-Louis Hospital, AP-HP, Université de Paris Paris, France 
g Unit of Molecular Mycology, Centre National de la Recherche Scientifique Unité Mixte de Recherche 2000, Institut Pasteur, Paris, France 
h Unit of Public Health, Department of Biostatistics, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France 
i Department of Pathology, Tenon Hospital, AP-HP, Paris, France 
j Department of Dermatology, Amiens University Hospital, Amiens, France 
k Department of Dermatology, Grenoble University Hospital, Grenoble, France 
l Department of Pathology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France 
m Department of Dermatology, DMU3ID, Tenon Hospital, AP-HP, Paris, France 

Correspondence to: Dr Stéphane Barete, MD, PhD, Unit of Dermatology, DMU3ID, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 bd de l'Hôpital F-75013 Paris, Sorbonne University, Paris, France.Unit of Dermatology, DMU3IDAP-HP, Hôpital Pitié-Salpêtrière47-83 bd de l'Hôpital F-75013 Paris, Sorbonne University, UPMC Paris-6ParisFrance
Abstract
Background

Deep cutaneous fungal infections (DCFIs) are varied in immunosuppressed patients, with few data for such infections in solid-organ transplant recipients (s-OTRs).

Objective

To determine DCFI diagnostic characteristics and outcome with treatments in s-OTRs.

Methods

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.

Results

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.

Limitations

Due to the retrospective observational design of the study.

Conclusions

Phaeohyphomycoses are the most common DCFIs in s-OTRs. Multidisciplinary teams are helpful for optimal diagnosis and management.

The full text of this article is available in PDF format.
Graphical abstract




The full text of this article is available in PDF format.

Key words : antifungal treatment, deep cutaneous fungal infection, phaeohyphomycosis, solid-organ transplant recipients

Abbreviations used : CNI, DCFI, IS, MMF, s-OTR



 Funding sources: Supported by Skin and Organ Transplantation Group of the French Society of Dermatology (Groupe Peau et Greffe d'organe de la Société Française de Dermatologie).
 Disclosure: Dr Lebbé received research grants or honoraria from Roche, Bristol-Myers Squibb, Merck Sharpe & Dohme, GlaxoSmithKline, Novartis, and Amgen outside the submitted work. Drs Galezowski, Delyon, Le Cleach, Guégan, Ducroux, Alanio, Lastennet, Moguilet, Dadban, Leccia, Pelletier, Francès, and Barete have no conflicts of interest to declare.
 IRB approval status: Informed consent in accordance with the Declaration of Helsinki.



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