Chagas' disease reactivation with skin symptoms in a patient with kidney transplant

Immunodepressed patients in the intermediate phase of Chagas' disease may undergo reactivation of the disease together with atypical symptoms. The case of an immunodepressed kidney transplant patient with reactivation of Chagas' disease with skin symptoms is reported. A 65-year-old man presented with infiltrated erythematous lesions on the anterior aspect of the right thigh of 2 weeks' duration. The lesions later extended to the abdomen, thorax, and lower limbs. In the histologic skin examination, amastigotes and Trypanosoma cruzi trypoamastigotes were observed. A fresh smear showed positive parasitemia. Using the Strout hemoconcentration method, multiple Trypanosoma cruzi trypoamastigotes with motility could be seen. Polymerase chain reaction was positive for Trypanosoma cruzi. An immunofluorescence test was positive (1 : 64) and there was hemoagglutination (1 : 32). Treatment was started with benznidazole, 7 mg/kg/day. The patient did not evolve favorably and died 20 days after hospitalization. Skin lesions may be a manifestation of the reactivation of Chagas' disease in immunosuppressed patients. All patients with positive Chagas' serology who require immunosuppressant drugs should receive specific treatment for Chagas' disease.     

Transient acantholytic dermatosis (Grover's disease) in a renal transplant patient

Grover's disease ("transient acantholytic dermatosis") is a transient dermatosis of unknown cause manifesting clinically as a papular skin eruption located usually on the anterior chest and abdomen and histologically with dyskeratosis and acantholysis. Grover's disease has occasionally been reported in patients with chronic renal failure, HIV infection, hematological malignancies and bone-marrow allotransplantation. We report herein a new case of Grover's disease that developed in a renal transplant patient. To the best of our knowledge, this is the first observation of Grover's disease developing in the setting of solid organ transplantation.     

Subcutaneous Fusarium foot abscess in a renal transplant patient.

Fusarium species are ubiquitous plant and grain phytopathogens that rarely cause opportunistic infections in immunocompromised patients. While disseminated Fusarium infections are almost always fatal, localized infections may be responsive to a combination of systemic antibiotic therapy and surgical debridement. We present a diabetic renal transplant patient who developed a foot abscess due to Fusarium solani. Infection persisted despite aggressive surgical debridement and a 3-month course of intravenous liposomal amphotericin B.     

EBV-associated cutaneous plasmocytoma in a renal transplant patient

INTRODUCTION: Postransplant lymphoproliferative disorders are well known complications of solid organ transplant, usually associated with Epstein-Barr virus (EBV). OBSERVATION: A 25 year old renal transplant patient presented with two subcutaneous nodules on the lower limb that appeared 3 years after a second renal transplantation. Biopsy of one nodule showed an EBV associated plasmocytoma located in the subcutaneous tissue. A complete systemic evaluation showed no evidence of extracutaneous involvement. The patient was treated with anti CD20 therapy (rituximab), and complete remission was achieved. DISCUSSION: Extranodular localisations of postransplant lymphoproliferative disorders are usually reported, but cutaneous localizations are rarely described. Histological presentation are various, but plasmocytoma-type is infrequent. Initial therapy of cutaneous EBV-associated postransplant lymphoproliferative disorders without extracutaneous involvement consists in reduction of the immunosuppression therapy and/or an antiviral treatment and prolonged surveillance. Treatment with monoclonal anti-CD20 antibodies (rituximab) is proposed.     

Larva currens in a patient scheduled for renal transplant

We present a case of larva currens in a patient scheduled for renal transplant. Larva currens is an eruption caused by Strongyloides stercoralis, characterized most often by a pathognomonic, migratory, rapidly extending, serpiginous, urticarial eruption. Infected patients who are immunocompromised are at risk for disseminated and often fatal infection. In disseminated disease, diffuse petechiae and purpura may be present, and periumbilical ecchymoses may resemble thumbprints. The dermatologist may be in a unique position to diagnose this condition and institute therapy. Although found endemically in the United States, the increasingly international nature of medical practice and transplantation medicine causes an increase in the number of patients who may present for evaluation.     

Calciphylaxis in a patient with end-stage renal disease.

Calciphylaxis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to small and medium-sized vessel calcification. It is seen almost exclusively in patients with end-stage renal disease and secondary hyperparathyroidism. We experienced a case of 67-year-old man with calciphylaxis that manifested with characteristic skin lesions, pathologic findings, and laboratory changes. His skin lesions began as painful erythematous patches and subsequently progressed to necrotic ulcers with eschars on the distal aspect of the extremities. Pathologically, calcification was found in small and medium-sized blood vessels in the deep dermis and subcutaneous tissue. His serum calcium was 9.5 mg/dL, phosphorus was 7.8 mg/dL, and nPTH was 99.9 pg/mL. The patient had been treated with surgical debridement and other supportive treatment. However, he eventually underwent an amputation below the right knee and died from sepsis.     

Unusual spindle cell squamous carcinoma in a renal transplant patient

The histopathological diagnosis of spindle cell tumours is often difficult. We present a patient who developed a painful tumour on his head 6 years after renal transplantation. Histologically, the tumour was first interpreted as scar tissue with an unusual fibrohistiocytic component. Cytokeratins, desmin, CD31, CD34 and S100 could not be detected using conventional immunohistochemistry. After two recurrences and intensive immunohistochemical examinations, cytokeratin-positive tumour areas in direct connection with the epidermis were detected. The final diagnosis was therefore spindle cell squamous carcinoma. The patient finally died from brain metastases after experiencing further painful recurrences that were removed surgically. Our case underscores the importance of refined immunohistochemical methods in establishing the diagnosis of spindle cell squamous carcinomas, methods that should be taken into account especially if painful spindle cell tumours arise on sun-exposed skin in immunosuppressed patients.     

Concurrent subcutaneous and visceral basidiobolomycosis in a renal transplant patient

Basidiobolomycosis is a chronic inflammatory disease that occurs exclusively in healthy individuals. Clinically, the infection is generally restricted to subcutaneous tissue; however, the disease has been documented to emerge in visceral organs but seldom spreads to cause disseminated infection. We describe the first culture-confirmed case of systemic Basidiobolus ranarum infection in an immunosuppressed patient. A 55-year-old female renal transplant recipient developed chronic hard nonpitting oedema of the right lower extremity and abdominal wall concurrent with the infection from the same organism involving the uterus, urinary bladder and intra-abdominal lymph nodes. The patient responded successfully, both clinically and radiographically, to medical therapy without surgical resection. The treatment regimen consisted of potassium iodide and trimethoprim/sulfamethoxazole for 3 months, and the patient remains clear of symptoms after 10 months' follow-up.