신이식 환자에서 피부증상으로 발현한 파종성 크립토코쿠스증 1예open accessDisseminated Cryptococcosis with Cutaneous Manifestation in a Renal Transplant Recipient: A Case Report
- Other Titles
- Disseminated Cryptococcosis with Cutaneous Manifestation in a Renal Transplant Recipient: A Case Report
- Authors
- 이상기; 김해수; 이정규; 최종민; 정인섭; 이지영; 황순우; 이창화; 권오정; 강종명
- Issue Date
- Sep-2013
- Publisher
- 대한이식학회
- Keywords
- Kidney transplantation; Cryptococcosis; Fungal infection; 신이식; 크립토코쿠스증; 진균 감염
- Citation
- 대한이식학회지, v.27, no.3, pp.132 - 137
- Indexed
- OTHER
- Journal Title
- 대한이식학회지
- Volume
- 27
- Number
- 3
- Start Page
- 132
- End Page
- 137
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/161904
- DOI
- 10.4285/jkstn.2013.27.3.132
- ISSN
- 1598-1711
- Abstract
- Cryptococcosis commonly affects patients with immune dysfunction, as in the case of immunosuppression in organ transplant patients or as acquired immunodeficiency syndrome in patients afflicted with human immunodeficiency virus. The varied appearance of cryptococcal skin lesion makes clinical diagnosis of cutaneous cryptococcosis difficult. Cryptococcosis proves to be a fatal fungal infection in the immunocompromised patient. Therefore, diagnosis and early treatment of cryptococcosis become vital. A 56-year-old renal transplant recipient, with an ongoing immunosuppression regimen of cyclosporine, prednisolone, and mycophenolate mofetil, was admitted with a 2-week history of pain and edema of right arm without respiratory symptoms. Despite empiric antibiotic therapy, the patient continued to complain of severe tenderness of the involved arm and fever persisted as well. On the third day of hospital stay, a biopsy of the erythematous skin lesion was acquired. On the eighth day of hospital stay, results of both skin biopsy and blood cultures showed the presence of Cryptococcus neoformans. The treatment was begun with intravenous fluconazole (400 mg/day). After 4 days of antifungal treatment, the patient developed fever along with cough with purulent sputum. As the new developing symptoms were suggestive of pneumonia, especially of pulmonary cryptococcosis, the antifungal agent was changed from fluconazole to amphotericin B treatment (0.8 mg/kg, 50 mg/day). Chest computer tomography showed improvement in the pneumonic infiltration and consolidation after 4 weeks of amphotericin B treatment. In conclusion, cellulitis in immunocompromised patients should be suspected in case of highly atypical infectious etiology, and skin biopsy should not be delayed if empiric antibiotic therapy does not control the inflammatory response. Additionally, the patient should be treated with intravenous amphotericin B treatment in case of severe cryptococcosis.
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