Nonneoplastic mucocutaneous lesions in organ transplant recipients

The Role of Excision for Treatment of Chromoblastomycosis: A Cutaneous Fungal Infection Frequently Mistaken for Squamous Cell Carcinoma

BACKGROUND

Chromoblastomycosis is an uncommon fungal infection of the skin caused by a variety of dematiaceous fungal species that is typically contracted through direct inoculation into the skin.

OBJECTIVE

To collect and examine data pertaining to the clinical presentation and management of patients with chromoblastomycosis.

METHODS

Through a retrospective study, a pathology medical record search was performed from January 2004 to December 2020 at a single institution.

RESULTS

A total of 9 patients were identified. Seven of 9 cases occurred in solid organ transplant recipients. All cases were located on the extremities. Six of 9 cases were clinically suspected to be squamous cell carcinoma. Seven of 9 cases were treated with surgical excision. Six of 9 patients were treated with oral antifungal medication. Four of 9 patients had received combination therapy. Eight of 9 patients had no recurrence of the disease after treatment.

CONCLUSION

Chromoblastomycosis presents as verrucous papules or nodules and may clinically and histopathologically mimic squamous cell carcinoma. Immunosuppression is likely a risk factor for the development of chromoblastomycosis. This study highlights the importance of clinical awareness of this disease's clinical presentation and prevalence in immunosuppressed patient populations.

Comparison of the Effect of Multimedia and Booklet Methods on Quality of Life of Kidney Transplant Patients: A Randomized Clinical Trial Study

Background:

Proper education can improve the quality of life. Multimedia as an interactive educational method and booklet as a traditional one have their own unique effects. This study aimed at compare the interactive multimedia and booklet methods at the time of discharge on the quality of life of kidney transplant patients

Methods:

In this single-blind interventional study, 80 patients from Bouali Hospital, Shiraz, from September 2017 until June 2018 were selected by convenience sampling, and then divided into two groups (booklet and interactive multimedia) by block randomization. Intervention for the first group included short and long-term care information in the form of a booklet, and an interactive multimedia CD with the same content for the second group. Quality of life was assessed by kidney transplant questionnaire (KTQ) at the time of discharge and after two months. Adherence to education was verified by phone. The data were analyzed through SPSS v.24 software using independent and paired t-tests. Plt;0.05 was considered significant

Results:

The mean overall quality of life score in both groups increased significantly, P=0.044 for the booklet group and P=0.039 for the multimedia group. In emotional, fatigue, uncertainty/fear domains, both groups showed improvement after the intervention (P<0.05). However, in physical symptoms and appearance domains, differences were not significant, before and after education. After intervention, no significant difference was observed between the two groups in the overall and specific domains of quality of life score (P=0.437)

Conclusion:

Both methods had positive impacts on the quality of life and emotional, fatigue and uncertainty/fear domains.

Trial Registration Number: IRCT201608272950N1

Dermatological Complications After Solid Organ Transplantation

Organ transplant recipients (OTRs) are a population at high risk for cutaneous adverse events. Their early recognition and appropriate treatment is an important component of the clinical management of OTRs and should be optimally dealt with by dermatologists working in the context of a transplant dermatology clinic. Skin examination should be a standard procedure before performing organ transplantation to assess conditions which may be difficult to manage after the transplant procedure has been performed or which may represent a contraindication to transplantation, e.g., malignant melanoma. It also offers an opportunity to educate patients on skin care after organ transplantation. Skin infections can occur at any time after organ transplantation and include viral, bacterial, and fungal opportunistic infections. The risk of reactivation of latent viruses, such as varicella-zoster virus (VZV) and cytomegalovirus (CMV), is high. Bacterial infections are frequent and may be caused by unusual agents such Actinomyces, Mycobacteria, Legionella, or Nocardia. A large spectrum of fungal infections may occur, ranging from superficial (e.g., dermatophytes) to deeper and more severe ones (Alternaria, Aspergillus, Cryptococcus, Histoplasma). Drug-related idiosyncratic reactions usually occur early after the introduction of the causative drug, e.g., hypersensitivity reaction to azathioprine. On the long-term run, cutaneous effects due to cumulative drug toxicity, e.g., sebaceous hyperplasia from cyclosporine, may appear. Rare immunologically driven inflammatory reactions may occur in OTRs such as GVH or autoimmune disease. Tumors are particularly frequent. Kaposi's sarcoma, associated with persistent human herpes virus 8 (HHV8) infection, and cutaneous anaplastic large-cell lymphoma (ALCL) occur early after transplantation. Other cancers, such as nonmelanoma skin cancer (NMSCs), associated with persistent human papillomavirus (HPV) infections, malignant melanoma, Merkel cell carcinoma, or adnexal tumors, manifest later with an incidence which is much higher than observed in the general population. The incidence increases further after a first NMSC occurs.

Leflunomide for the treatment of trichodysplasia spinulosa in a liver transplant recipient

Trichodysplasia spinulosa (TS) is a rare dermatologic complication associated with the immunosuppressive therapy used in solid organ transplantation. The distinctive clinical manifestation of this condition is spiny follicular papules on the face, ears, extremities, and trunk. Histopathologically, abnormally maturing hair follicles with hyperkeratotic material are noted. The condition is produced by the trichodysplasia spinulosa-associated polyomavirus. Treatment of this condition in the past has entailed a reduction in immunosuppression, topical agents such as cidofovir or retinoids, or oral valganciclovir. Herein, we report a case of generalized TS treated successfully with leflunomide.