Nontumoral dermatologic problems after liver transplantation

Anticancer Therapy in COViD-19 Patients: A Descriptive Literature Review

OBJECTIVE

To provide a descriptive literature review about the effects of anticancer treatment on clinical outcomes because of active COVID-19 infection in older people.

DATA SOURCES

A literature search was conducted in Google Scholar, PubMed, American Society of Clinical Oncology, European Society for Medical Oncology, and the Center for Disease Control and Prevention. Articles published in English between December 1, 2019, to September 1, 2020, were included.

STUDY SELECTION

Nine studies assessing the effectiveness of various modalities for cancer treatments in patients infected with COVID-19 infection were reviewed. The studies reviewed the severity of COVID-19 infection outcomes in patients who underwent any anticancer treatment. Studies exclusively focused on older people could not be found, but all studies included older people. DATA SYNTHESiS AND RESULTS: Early pandemic studies suggested avoiding anticancer treatment during a COVID-19 infection because of poor clinical outcomes and increased mortality. However, the totality of studies reviewed found no association between the continuation of anticancer treatment and adverse COVID-19 outcomes in cancer patients. Adverse COVID-19 infection outcomes and high mortality rates were associated with older cancer patients independent of anticancer therapy.

CONCLUSION

Treatment of cancer could be challenging because of the COVID-19 pandemic. Interruption or delaying the anticancer therapy could increase the burden of overall mortality. This literature review indicated that adverse outcomes because of COVID-19 are associated with advanced age independent of anticancer therapy. Further exploration of the correlation between cancer, anticancer treatments, and COVID-19 infection outcomes is needed.

Dermatologic manifestations in pediatric patients after liver and HSCT: A 20-year retrospective cohort study

LT and HSCT are now potentially curative treatments for many medical conditions. Dermatologic manifestations are one of the sequelae after transplantation. To study the prevalence and associated risk factors of dermatologic manifestations after pediatric LT and HSCT. A 20-year retrospective cohort study was conducted in children, aged ≤15 years, who received LT or HSCT from January 1, 1997, to December 31, 2017. Medical records were reviewed for data collection until December 31, 2018. A total of 70 LT and 51 HSCT recipients were included. The percentages of overall dermatologic manifestations after LT and HSCT were 64.3% and 64.7%, respectively. Viral infection was the most common manifestation in both groups, with mucocutaneous HSV infection as the most prevalent. One HSCT recipient developed leukemia cutis. GVHD was revealed in 27.5% of HSCT recipients. Impetigo and xerosis were significantly observed in patients using azathioprine and prednisolone. Approximately two-thirds of pediatric LT and HSCT recipients experienced dermatologic manifestations, potentially associated with immunosuppressive agents. Thus, regular skin examination and optimized immunosuppression would be beneficial in these recipients.

Dermatological signs in liver transplant recipients

BACKGROUND

In recent years, the number of liver transplantations for advanced-stage liver diseases has considerably increased and the patients have a wide range of dermatologic manifestations.

AIM

This study aims to reveal cutaneous, mucosal, and nail lesions in liver transplant recipients in quite large patient series.

PATIENTS/METHODS

The study included 520 patients in the Inonu University Liver Transplantation Institute. New and followed-up patients attended to the study between May and October 2019. The patients were examined by a dermatologist, and their data were recorded.

RESULTS

The study included 163 female and 357 male patients with the main age of 44.20 ± 18.18 (range: 1-83 years), and 465 livers (89.4%) were taken from live donors, while 54 livers (10.4%) were taken from cadavers. A total of 314 (60.4%) patients had dermatophyte infections, 174 (33.4%) patients had pathological nail changes, and 427 (82.1%) patients had oral mucosal lesions. Graft-versus-host disease (GVHD) developed in 9 (1.73%) patients after the transplantation, and 5 patients died of GVHD. Four patients had cutaneous malignancies.

CONCLUSIONS

Tumoral and nontumoral dermatological diseases may be encountered following the transplantation depending on underlying liver disease, immunosuppressive treatment, the graft itself, or any primary cutaneous disease. Liver transplantation recipients require a multidisciplinary clinical approach, and dermatological care must be an integral part of this approach.

Dermatological Disorders following Liver Transplantation: An Update

Patients undergoing liver transplantation (LT) are at a high risk of dermatological complications compared to the general population as a result of long-term use of immunosuppressant. However, the risk is not as high as other solid organ transplantations (SOT), particularly for skin cancer. The liver is considered as an immune privileged organ since it has a low prevalence of humoral rejection in contrast to other SOT, and thus, LT requires a minimal amount of immunosuppressants compared to other SOT recipients. However, because of the large volume of the liver, patients with LT have higher donor lymphocytes that sometimes may trigger graft-versus-host-disease, yet it is rare. On the other hand, the vast majority of the nonspecific dermatological lesions linked with cirrhosis improve after removal of diseased liver or due to the immunosuppressant used after LT. Nevertheless, dermatological infections related to bacteria, viruses, and fungus after LT are not uncommon. Additionally, the incidence of IgE-mediated food allergies develops in 12.2% of LT patients and may present as life-threatening conditions such as urticaria and/or angioedema and hypersensitivity. Moreover, skin malignancies after LT are a matter of concern. Thus, posttransplant dermatological care should be provided to all LT patients for any suspicious dermatological lesions. Our goal is to give an outline of the dermatological manifestation associated with LT for the clinicians by collecting the published data from all archived case reports.

Risk of infectious diseases and cutaneous tumours in solid organ recipients: A meta-analysis of literature

AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.

METHODS: In the present work, we evaluated the incidence of bacterial, fungal and viral cutaneous infectious diseases and the development of skin cancers in a cohort of 436 patients who underwent a renal transplantation. The median age at transplantation of our patients was 50 years and the median duration of the immunosuppression was of 7.2 years. Data obtained from our cohort were compared with those obtained by a systematic review of the literature of the last 20 years about the same topic.

RESULTS: Infectious diseases were the most frequent dermatological disorders that were diagnosed after transplantation, affecting about the 16.5% of patients. Herpes virus reactivation occurs in about the 35% of patients and is more common within 6 mo from transplantation, whereas when the immunosuppression is reduced, skin infections are mainly represented by Human Papilloma Virus infections and localized mycosis, such as pityriasis versicolor and superficial candidiasis. Bacterial infections were relatively rare and occur mainly in the first months after transplantation. The cumulative risk to develop skin cancer enhance significantly over the time, as consequence of long-term immunosuppressive regiments. Endogenous and exogenous risk factors, as well as the schedule of immunosuppression can play a role and justify the different incidence of skin cancer in the various series.

CONCLUSION: Skin infections and cancer, commonly diagnosed in transplanted patients, impact on survival and life-quality, justifying the realization of follow-up programs for the early diagnosis and treatment.

[Skin infections after transplantation]

Skin infections after transplantation are frequent and of special importance because they may be quite severe. The spectrum of dermatologic infections in transplant recipients includes bacterial, mycotic and viral diseases. Pyoderma, herpes virus 6/7, herpes simplex virus, varicella-zoster virus, cytomegalovirus and candida infections predominate. Rare pathogens must be also considered. Cutaneous infections can be divided into three phases following transplantation. Diagnosis and adequate early therapy together with specific prophylaxis and follow-up of transplant patients should be strived for to avoid life-threatening complications.

Skin infections in organ transplant recipients

In contrast to the well-described high risk of skin cancer in organ transplant recipients, skin infections in these patients are not as well explored. Skin infections caused by viruses, bacteria or fungi represent a growing diagnostic and therapeutic challenge in the dermatological aftercare of organ transplant recipients. Differing immunosuppressive drugs and their variable dosage in chronologic sequence after transplantation probably influence the type and appearance of skin infections. The typical chronology of skin infections are wound infections, pyoderma or the reactivation of herpes viruses in the first month post-transplant; the main problems in months 2-5 are opportunistic infections and reactivation of varicella-zoster virus. After 6 months as immunosuppression is reduced, the spectrum of causative organisms approaches that of the general population; mycoses and human papilloma virus (HPV) infections dominate. A causal connection exists between infection with oncogenic viruses such as HPV, Epstein-Barr virus and human herpesvirus 8 and specific skin cancers (squamous cell carcinoma, Kaposi sarcoma and post-transplant lymphoproliferative disorders). Dermatological care of organ transplant recipients using appropriate diagnostic methods adapted to the modified clinical pattern may lead to early adequate treatment.

Phaéohyphomycose sous-cutanée à Exophiala spinifera chez une malade greffée rénale

INTRODUCTION

Among the dematiaceous fungi responsible for human or animal phaeohyphomycosis, the Exophiala genus is a well-known etiologic agent and presently includes nine species considered as opportunist pathogens. To our knowledge, Exophiala spinifera has been reported as causative agent of only thirteen cases of cutaneous or systemic phaeohyphomycosis. We describe some typical phaeohyphomycotic cysts.

CASE-REPORT

A 59 year-old female renal transplant recipient, treated with ciclosporine and prednisone, presented with two painless nodular and suppurative lesions of the leg, extending slowly. Histological and microbiological examinations identified Exophiala spinifera. The patient's condition improved with voriconazole treatment.

DISCUSSION

Phaeohyphomycosis is a rare but cosmopolitan mycosis found throughout the world. Immunocompromised hosts are more vulnerable to these infections and more likely to develop severe and disseminated forms of uncertain outcome. Mycological and histological findings are important to confirm the diagnosis. The prognosis is benign and complete cure is common in cutaneous and superficial forms. Treatment is not well defined, often empirical and usually relies on antifungals and/or complete surgical resection.