Atypical cellulitis in transplant recipients: A case report and review of the literature

Cellulitis is commonly seen in both immunocompetent and immunosuppressed patients. Immunosuppression used in transplant recipients places patients at risk of both typical and atypical cellulitis, with the potential for serious consequences in the event of delayed or missed diagnosis1. Atypical infections including mycobacterial and fungal infections of the skin are more common in immunosuppressed patients due to an altered immune response1, 2.
We report a 59-year-old kidney transplant recipient with a one-month history of bilateral lower limb cellulitis without signs or symptoms to suggest systemic illness. After failure of standard treatment for cellulitis with flucloxacillin a skin biopsy was performed to exclude atypical aetiologies. This confirmed cryptococcal cellulitis. Additional investigations revealed disseminated cryptococcosis necessitating urgent treatment with liposomal amphotericin B and flucytosine followed by fluconazole. This achieved a good clinical response.
Our case highlights the importance of early investigation and targeted treatment of cellulitis in immunocompromised hosts to avoid potentially serious complications.
1. Tsambaos D, Badavanis G. Skin Manifestations in Solid Organ Transplant Recipients. Skin Pharmacol Physiol. 2001; 14: 332-343.
2. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA. 2016; 316(3): 325-337.

Dr. Katrina Chakradeo

Queensland Institute of Dermatology and Veracity Clinical Research

Katrina Chakradeo is a physician trainee from Queensland with an interest in medical dermatology and immunology. Currently, she is working as an honorary dermatology registrar at the Queensland Institute of Dermatology and Veracity Clinical Research in Brisbane with the goal of pursuing a career in dermatology.