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A Case of Primary Cutaneous Aspergillosis in a Renal Transplant Recipient

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Author(s)
박성배황은아한승엽김현철박관규
Alternative Author(s)
Park, Sung BaeHwang, Eun AhHan, Seung YeupKim, Hyun ChulPark, Kwan Kyu
Publication Year
2004
Abstract
Opportunistic fungal infections are life-threatening complications which are a major cause
of morbidity and mortality in immunocompromized hosts such as those who have
undergone organ transplantation. Aspergillosis comprises a spectrum of disease caused by
a ubiquitous saprophytic mold. Invasive aspergillus is a serious life-threatening complica-
tion in immunocompromised hosts.
Primary cutaneous aspergillosis occurs relatively less frequently and is poorly charac-
terized. We report a case of cutaneous aspergillosis in a 51-year-old renal transplant
recipient, which was successfully treated with local excision and concomitant antifungal
therapy.
Case. A 51-year-old male renal transplant recipient presented with cutaneous nodules
on the dorsum of the right hand. He underwent renal transplantation for end-stage renal
disease due to adult dominant polycystic kidney disease (ADPKD) 3 years prior. Initially
he suffered an acute rejection episode that was treated with steroid pulse and OKT3
therapy. Eventually he was stabilized on a combination of tacrolimus, prednisone, and
mycophenolate mofetil. Three years after transplanation, he developed painless multiple
(largest one 5X3 cm sized) nodules on the dorsum of his right hand. He was afebrile with
no systemic symptoms. A skin biopsy showed a dense solid infiltration of giant cells,
histiocytes, and lymphoplasma cells admixed with intra- and extracelluar fungal hyphae
and spores. The hyphae were septate and acute angle branching, which was consistent with
aspergillosis. Oral itraconazole 200 mg/d for 5 weeks was ineffective. Treatment with
liposomal amphotericin B for 4 weeks was initated and MMF was discontinued. The
medication was well tolerated with no hepatotoxic effects. Although new lesions did not
appear, existing ones did not significantly improve after 4 weeks of treatment. Therefore,
most lesions were excised surgically and liposomal amphotericin B continued for 2 weeks
followed by treatment with oral fluconazole for 2 months. Ten moths later there was no
evidence of recurrence.
Department
Dept. of Internal Medicine (내과학)
Dept. of Pathology (병리학)
Publisher
School of Medicine
Citation
Transplantation Proceedings, Vol.36(7) : 2156-2157, 2004
Type
Article
ISSN
0041-1345
DOI
10.1016/j.transproceed.2004.08.050
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34713
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