Current Infectious Disease Reports

, Volume 10, Issue 5, pp 387–393

Skin and soft tissue infections in the transplant population



Solid organ and hematopoietic stem cell transplant recipients are more likely to develop skin and soft tissue infections, which may be caused by common or atypical pathogens. Skin and soft tissue anatomic abnormalities may act as portals of entry for infection, and may result from surgery, venous access, immunosuppressive medications, and other etiologies. Systemic infection may sometimes be recognized by investigation of skin manifestations. Many noninfectious processes of the skin and soft tissues can mimic infection, complicating the diagnosis. Prompt dermatologic consultation and skin biopsy are essential in this vulnerable population. Treatment of infection in transplant recipients may necessitate reduction of immunosuppression, in addition to other adjunctive therapies. Interesting and important new findings about skin and soft tissue infections in transplant recipients are the focus of this review.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    McGuinn ML, Lawrence ME, Proia L, Segreti J: Progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient. Transplant Proc 2005, 37:4313–4314.PubMedCrossRefGoogle Scholar
  2. 2.
    Seyahi N, Apaydin S, Kahveci A, et al.: Cellulitis as a manifestation of miliary tuberculosis in a renal transplant recipient. Transpl Infect Dis 2005, 7:80–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Harada AS, Lau W: Successful treatment and limb salvage of mucor necrotizing fasciitis after kidney transplantation with posaconazole. Hawaii Med J 2007, 66:68–71.PubMedGoogle Scholar
  4. 4.
    Basaran O, Emiroglu R, Arikan U, et al.: Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities. Dermatol Surg 2003, 29:1158–1160.PubMedCrossRefGoogle Scholar
  5. 5.
    Wai PH, Ewing CA, Johnson LB, et al.: Candida fasciitis following renal transplantation. Transplantation 2001, 72:477–479.PubMedCrossRefGoogle Scholar
  6. 6.
    Mahe E, Morelon E, Lechaton S, et al.: Cutaneous adverse events in renal transplant recipients receiving sirolimus-based therapy. Transplantation 2005, 79:476–482.PubMedCrossRefGoogle Scholar
  7. 7.
    Mehrabi A, Fonouni H, Wente M, et al.: Wound complications following kidney and liver transplantation. Clin Transplant 2006, 20(Suppl 17):97–110.PubMedCrossRefGoogle Scholar
  8. 8.
    Hogewoning AA, Goettsch W, van Loveren H, et al.: Skin infections in renal transplant recipients. Clin Transplant 2001, 15:32–38.PubMedCrossRefGoogle Scholar
  9. 9.
    Euvrard S, Kanitakis J, Cochat P, et al.: Skin diseases in children with organ transplants. J Am Acad Dermatol 2001, 44:932–939.PubMedCrossRefGoogle Scholar
  10. 10.
    Alimagham M, Amini-Afshar S, Farahmand S, et al.: Frequency of infectious skin lesions in kidney transplant recipients. Urol J 2005, 2:193–196.PubMedGoogle Scholar
  11. 11.
    Kotton CN: Zoonoses in solid-organ and hematopoietic stem cell transplant recipients. Clin Infect Dis 2007, 44:857–866.PubMedCrossRefGoogle Scholar
  12. 12.
    Prakash J, Singh S, Prashant GK, et al.: Mucocutaneous lesions in transplant recipient in a tropical country. Transplant Proc 2004, 36:2162–2164.PubMedCrossRefGoogle Scholar
  13. 13.
    Erikoglu M, Tavli S, Turk S: Fournier’s gangrene after renal transplantation. Nephrol Dial Transplant 2005, 20:449–450.PubMedCrossRefGoogle Scholar
  14. 14.
    Walther PJ, Andriani RT, Maggio MI, Carson CC 3rd: Fournier’s gangrene: a complication of penile prosthetic implantation in a renal transplant patient. J Urol 1987, 137:299–300.PubMedGoogle Scholar
  15. 15.
    Wolf SC, Kempf VA, Tannapfel A, et al.: Secondary syphilis after liver transplantation: case report and review of the literature. Clin Transplant 2006, 20:644–649.PubMedCrossRefGoogle Scholar
  16. 16.
    Ram R, Uppin S, Swarnalatha G, et al.: Isolated skin ulcers due to Mycobacterium tuberculosis in a renal allograft recipient. Nat Clin Pract Nephrol 2007, 3:688–693.PubMedCrossRefGoogle Scholar
  17. 17.
    Jang EY, Lee SO, Choi SH, et al.: Case of pyomyositis due to Mycobacterium haemophilum in a renal transplant recipient. J Clin Microbiol 2007, 45:3847–3849.PubMedCrossRefGoogle Scholar
  18. 18.
    George SJ, Rivera AM, Hsu S: Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum. Dermatol Online J 2006, 12:13.PubMedGoogle Scholar
  19. 19.
    Miller GG, Dummer JS: Herpes simplex and varicella zoster viruses: forgotten but not gone. Am J Transplant 2007, 7:741–747.PubMedCrossRefGoogle Scholar
  20. 20.
    Avery RK, Michaels M: Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant 2008, 8:9–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Weinstock DM, Boeckh M, Sepkowitz KA: Postexposure prophylaxis against varicella zoster virus infection among hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant 2006, 12:1096–1097.PubMedCrossRefGoogle Scholar
  22. 22.
    Chan Y, Smith D, Sadlon T, et al.: Herpes zoster due to Oka vaccine strain of varicella zoster virus in an immunosuppressed child post cord blood transplant. J Paediatr Child Health 2007, 43:713–715.PubMedCrossRefGoogle Scholar
  23. 23.
    Manuel O, Kumar D, Singer LG, et al.: Incidence and clinical characteristics of herpes zoster after lung transplantation. J Heart Lung Transplant 2008, 27:11–16.PubMedCrossRefGoogle Scholar
  24. 24.
    Arness T, Pedersen R, Dierkhising R, et al.: Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Transpl Infect Dis 2007 (Epub ahead of print).Google Scholar
  25. 25.
    Hata A, Asanuma H, Rinki M, et al.: Use of an inactivated varicella vaccine in recipients of hematopoietic-cell transplants. N Engl J Med 2002, 347:26–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Tan HH, Goh CL: Viral infections affecting the skin in organ transplant recipients: epidemiology and current management strategies. Am J Clin Dermatol 2006, 7:13–29.PubMedCrossRefGoogle Scholar
  27. 27.
    Ara M, Zaballos P, Sanchez M, et al.: Giant and recurrent orf virus infection in a renal transplant recipient treated with imiquimod. J Am Acad Dermatol 2008, 58(2 Suppl):S39–S40.PubMedCrossRefGoogle Scholar
  28. 28.
    Gardner LS, Ormond PJ: Treatment of multiple giant molluscum contagiosum in a renal transplant patient with imiquimod 5% cream. Clin Exp Dermatol 2006, 31:452–453.PubMedCrossRefGoogle Scholar
  29. 29.
    Muetherig A, Christopeit M, Muller LP, et al.: Human parvovirus B19 infection with GvHD-like erythema in two allogeneic stem cell transplant recipients. Bone Marrow Transplant 2007, 39:315–316.PubMedCrossRefGoogle Scholar
  30. 30.
    Stallone G, Schena A, Infante B, et al.: Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 2005, 352:1317–1323.PubMedCrossRefGoogle Scholar
  31. 31.
    Wallet-Faber N, Bodemer C, Blanche S, et al.: Primary cutaneous Epstein-Barr virus-related lymphoproliferative disorders in 4 immunosuppressed children. J Am Acad Dermatol 2008, 58:74–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Feng H, Shuda M, Chang Y, Moore PS: Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008, 319:1096–1100.PubMedCrossRefGoogle Scholar
  33. 33.
    Gulec AT, Demirbilek M, Seckin D, et al.: Superficial fungal infections in 102 renal transplant recipients: a case-control study. J Am Acad Dermatol 2003, 49:187–192.PubMedCrossRefGoogle Scholar
  34. 34.
    Berg JC, Hamacher KL, Roberts GD: Pseudomycetoma caused by Microsporum canis in an immunosuppressed patient: a case report and review of the literature. J Cutan Pathol 2007, 34:431–434.PubMedCrossRefGoogle Scholar
  35. 35.
    Lanternier F, Chandesris MO, Poiree S, et al.: Cellulitis revealing a cryptococcosis-related immune reconstitution inflammatory syndrome in a renal allograft recipient. Am J Transplant 2007, 7:2826–2828.PubMedCrossRefGoogle Scholar
  36. 36.
    Vagefi PA, Cosimi AB, Ginns LC, Kotton CN: Cutaneous Aspergillus ustus in a lung transplant recipient: emergence of a new opportunistic fungal pathogen. J Heart Lung Transplant 2008, 27:131–134.PubMedCrossRefGoogle Scholar
  37. 37.
    Almyroudis NG, Sutton DA, Linden P, et al.: Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature. Am J Transplant 2006, 6:2365–2374.PubMedCrossRefGoogle Scholar
  38. 38.
    Nouri-Majalan N, Moghimi M: Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report. J Medical Case Reports 2008, 2:112.CrossRefGoogle Scholar
  39. 39.
    Gilaberte M, Bartralot R, Torres JM, et al.: Cutaneous alternariosis in transplant recipients: clinicopathologic review of 9 cases. J Am Acad Dermatol 2005, 52:653–659.PubMedCrossRefGoogle Scholar
  40. 40.
    Gauthier GM, Safdar N, Klein BS, Andes DR: Blastomycosis in solid organ transplant recipients. Transpl Infect Dis 2007, 9:310–317.PubMedCrossRefGoogle Scholar
  41. 41.
    Ezzedine K, Wissing KM, Jacobs F, et al.: Recurrent Scedosporium apiospermum skin infection in a renal transplant recipient. J Eur Acad Dermatol Venereol 2008 (Epub ahead of print).Google Scholar
  42. 42.
    Mays SR, Bogle MA, Bodey GP: Cutaneous fungal infections in the oncology patient: recognition and management. Am J Clin Dermatol 2006, 7:31–43.PubMedCrossRefGoogle Scholar
  43. 43.
    Ozcan D, Gulec AT, Haberal M: Multiple subcutaneous nodules leading to the diagnosis of pulmonary aspergillosis in a renal transplant recipient. Clin Transplant 2008, 22:120–123.PubMedGoogle Scholar
  44. 44.
    Gallerano V, Consigli J, Pereyra S, et al.: Chagas’ disease reactivation with skin symptoms in a patient with kidney transplant. Int J Dermatol 2007, 46:607–610.PubMedCrossRefGoogle Scholar
  45. 45.
    Antinori S, Cascio A, Parravicini C, et al.: Leishmaniasis among organ transplant recipients. Lancet Infect Dis 2008, 8:191–199.PubMedCrossRefGoogle Scholar
  46. 46.
    Mirzabeigi M, Farooq U, Baraniak S, et al.: Reactivation of dormant cutaneous Leishmania infection in a kidney transplant patient. J Cutan Pathol 2006, 33:701–704.PubMedCrossRefGoogle Scholar
  47. 47.
    Lee SA, Diwan AH, Cohn M, et al.: Cutaneous toxoplasmosis: a case of confounding diagnosis. Bone Marrow Transplant 2005, 36:465–466.PubMedCrossRefGoogle Scholar
  48. 48.
    Weng FL, Pancoska C, Patel AM: Fatal graft-versus-host disease presenting as fever of unknown origin in a pancreas-after-kidney transplant recipient. Am J Transplant 2008, 8:881–883.PubMedCrossRefGoogle Scholar
  49. 49.
    Tan DH, Bunce PE, Liles WC, Gold WL: Gemcitabine-related “pseudocellulitis”: report of 2 cases and review of the literature. Clin Infect Dis 2007, 45:e72–e76.PubMedCrossRefGoogle Scholar
  50. 50.
    Hammond-Thelin LA: Cutaneous reactions related to systemic immunomodulators and targeted therapeutics. Dermatol Clin 2008, 26:121–159, ix.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases DivisionMassachusetts General HospitalBostonUSA

Personalised recommendations