Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review

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 one 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

Twelve patients were included (8 men, median age of 56 years [range: 33-71]). Ten were kidney transplant. 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 three 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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