Immunosuppressants

Immunosuppressants Reactions 1704, p196 - 2 Jun 2018 Microsphaeropsis arundinis infection and coagulase negative Staphylococcus infection: 2 case reports In a case series, a 69-year-old woman developed cutaneous Microsphaeropsis arundinis (M. arundinis) fungal infection and coagulase negative Staphylococcus bacterial infection following treatment with prednisone, tacrolimus, mycophenolate mofetil and budesonide, while a 65 year-old- man developed cutaneous M. arundinis fungal infection following treatment with azathioprine, prednisone and tacrolimus [dosages, time to reactions onsets not stated; not all routes stated]. Case 1: A 69-year-old woman presented with a 6-month history of an asymptomatic scar-like plaque on the right hand dorsum, which started as a laceration during gardening and developed into a crusted plaque. Her relevant medical history included renal transplantation due to renal failure of an unknown aetiology, which required immunosuppression treatment with prednisone, tacrolimus and mycophenolate mofetil. She had been also taking budesonide inhaler along with various other concurrent medications. An examination showed a single linear hyperkeratotic plaque covering the second metacarpophalangeal joint. Laboratory tests showed underlying stable hyponatraemia along with slightly increased creatinine and urea. All other findings were normal. A punch biopsy specimen was collected for microbiology and histology including fungal and mycobacterial cultures. The histopathology and staining showed numerous fungal elements. Fungal culture was positive for M arundinis, while bacterial culture was positive for coagulase negative Staphylococcus. The infections were considered to be related to the immunosuppression treatment. Therefore, she was started on a itraconazole for 6 months. One month after itraconazole initiation, substantial reduction in the lesion size was noted. Case 2: A 65-year-old man presented with a 12 month th history of nodules on legs and dorsum 5 left toe. His relevant medical history included renal transplantation due to diabetic nephropathy, which required immunosuppression treatment with prednisone, tacrolimus and azathioprine. He had been also taking an unspecified darbepoetin along with various other concurrent medications. An examination showed three th ulcerated exophytic plaques on the right medial calf, left 5 toe and left posterior calf in a sporotrichoid distribution. The tissue was found to be friable and discharged serous fluid. Three incisional biopsies showed markedly hyperplastic epidermis with pseudoepitheliomatous hyperplasia and keratoacanthoma-like changes covering suppurative granulomatous inflammation and abscess formation within the dermis. An Alcian blue periodic acid Schiff stain revealed septate pseudohyphae and yeast-like structures within the inflamed dermis. A panfungal nucleic acid detection revealed M. arundinis DNA by PCR and DNA sequencing. The M. arundinis infection and associated complications were considered ot be related to the immunosuppression treatment. He was treated with voriconazole for 6 months, which showed clinical improvement of the lesions. Meanwhile, the dose of tacrolimus was reduced. Author comment: "Microsphaeropsis arundinis is a dematiaceous mold of the coelomycetes class that is emerging as a cause of opportunistic cutaneous infections in immunocompromised hosts." "Similarly, both the cases described in our cases series were postrenal transplant recipients on long term immunosuppression to prevent organ rejection." Nguyen Y, et al. Cutaneous Microsphaeropsis arundinis infection in renal transplant recipients-A report of 2 cases and review of the literature. JAAD Case Reports 4: 415-417, No. 5, Jun 2018. Available from: URL: http://doi.org/10.1016/ j.jdcr.2017.11.012 - Australia 803323756 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Immunosuppressants

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46839-5
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p196 - 2 Jun 2018 Microsphaeropsis arundinis infection and coagulase negative Staphylococcus infection: 2 case reports In a case series, a 69-year-old woman developed cutaneous Microsphaeropsis arundinis (M. arundinis) fungal infection and coagulase negative Staphylococcus bacterial infection following treatment with prednisone, tacrolimus, mycophenolate mofetil and budesonide, while a 65 year-old- man developed cutaneous M. arundinis fungal infection following treatment with azathioprine, prednisone and tacrolimus [dosages, time to reactions onsets not stated; not all routes stated]. Case 1: A 69-year-old woman presented with a 6-month history of an asymptomatic scar-like plaque on the right hand dorsum, which started as a laceration during gardening and developed into a crusted plaque. Her relevant medical history included renal transplantation due to renal failure of an unknown aetiology, which required immunosuppression treatment with prednisone, tacrolimus and mycophenolate mofetil. She had been also taking budesonide inhaler along with various other concurrent medications. An examination showed a single linear hyperkeratotic plaque covering the second metacarpophalangeal joint. Laboratory tests showed underlying stable hyponatraemia along with slightly increased creatinine and urea. All other findings were normal. A punch biopsy specimen was collected for microbiology and histology including fungal and mycobacterial cultures. The histopathology and staining showed numerous fungal elements. Fungal culture was positive for M arundinis, while bacterial culture was positive for coagulase negative Staphylococcus. The infections were considered to be related to the immunosuppression treatment. Therefore, she was started on a itraconazole for 6 months. One month after itraconazole initiation, substantial reduction in the lesion size was noted. Case 2: A 65-year-old man presented with a 12 month th history of nodules on legs and dorsum 5 left toe. His relevant medical history included renal transplantation due to diabetic nephropathy, which required immunosuppression treatment with prednisone, tacrolimus and azathioprine. He had been also taking an unspecified darbepoetin along with various other concurrent medications. An examination showed three th ulcerated exophytic plaques on the right medial calf, left 5 toe and left posterior calf in a sporotrichoid distribution. The tissue was found to be friable and discharged serous fluid. Three incisional biopsies showed markedly hyperplastic epidermis with pseudoepitheliomatous hyperplasia and keratoacanthoma-like changes covering suppurative granulomatous inflammation and abscess formation within the dermis. An Alcian blue periodic acid Schiff stain revealed septate pseudohyphae and yeast-like structures within the inflamed dermis. A panfungal nucleic acid detection revealed M. arundinis DNA by PCR and DNA sequencing. The M. arundinis infection and associated complications were considered ot be related to the immunosuppression treatment. He was treated with voriconazole for 6 months, which showed clinical improvement of the lesions. Meanwhile, the dose of tacrolimus was reduced. Author comment: "Microsphaeropsis arundinis is a dematiaceous mold of the coelomycetes class that is emerging as a cause of opportunistic cutaneous infections in immunocompromised hosts." "Similarly, both the cases described in our cases series were postrenal transplant recipients on long term immunosuppression to prevent organ rejection." Nguyen Y, et al. Cutaneous Microsphaeropsis arundinis infection in renal transplant recipients-A report of 2 cases and review of the literature. JAAD Case Reports 4: 415-417, No. 5, Jun 2018. Available from: URL: http://doi.org/10.1016/ j.jdcr.2017.11.012 - Australia 803323756 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

References

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