Skin and Soft Tissue Infection in Transplant Recipients

  • Robert G. Micheletti
  • Carrie L. KovarikEmail author


Transplant-related immunosuppression is an important risk factor for the development of infectious diseases. The skin, as barrier to the outside world and the body’s largest organ, is particularly susceptible to both primary and disseminated infection. For the astute and thorough clinician, the skin is a useful marker of the health of the patient. It may provide clues to systemic disease and offers a chance at early diagnosis and prompt intervention.

Transplant patients are susceptible to both common and rare infections, which may present typically or atypically. As in other patients, Staphylococcus and Streptococcus frequently cause disease in the form of cellulitis, folliculitis/furunculosis, or impetigo. Gram-negative bacteria classically cause rapidly progressive cellulitis with hemorrhagic bullae or ecthyma gangrenosum, often in the setting of sepsis. Reactivation of HSV or VZV is common; its presentation may be highly atypical, with chronic verrucous or ulcerated plaques. Invasive aspergillosis and other mold infections are a relatively common complication of prolonged neutropenia. Violaceous, necrotic, infarcted-appearing plaques signal angioinvasion. Widespread erythematous or purpuric papules with pale, necrotic centers are typical of disseminated Candida.

In addition to these classic presentations of relatively common entities, many other atypical or unusual life-threatening infections can be seen in immunocompromised transplant patients. Prompt recognition and diagnosis are best accomplished through thorough physical examination and appropriate, directed diagnostic studies.


Transplant Immunosuppression Skin infection Opportunistic infection Virus Bacteria Fungus Skin infestations 


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of Medicine and DermatologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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