Abstract: SA-PO1038
Skin Lesions in a Kidney Transplant Recipient: Key to Early Diagnosis
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Swamy, Varsha, The University of Chicago, Chicago, Illinois, United States
- Friedman, Daniel, The University of Chicago, Chicago, Illinois, United States
- Concepcion, Beatrice P., The University of Chicago, Chicago, Illinois, United States
Introduction
Kidney transplant recipients are at risk for opportunistic infections. We present a case of a KT recipient who presented with hypoxia and skin lesions.
Case Description
A 66-year-old male with past medical history of end-stage kidney disease diabetes, and hypertension received a deceased donor kidney transplant with thymoglobulin induction. Maintenance immunosuppression included tacrolimus, mycophenolate, and prednisone.
Two years after transplant, he presented with 1 week of shortness of breath, hypoxia, and nonpruritic, nonpainful, verrucous and violaceous lesions on his right lower extremity, left lower extremity, dorsal aspect of left hand, and upper lip. He had no recent travel or sick contacts. He had stable graft function. CT scan of the chest showed multiple bilateral pulmonary nodules, cavitary right lower lobe consolidation, and right hilar and mediastinal adenopathy. On hospital day 1, he was started on amphotericin at 3mg/kg for suspected disseminated blastomycoses. Punch biopsy of one lesion showed focal areas of neutrophilic inflammation with broad budding yeasts consistent with blastomycosis and ultimately grew rare Blastomycoses dermatitis. Blastomyces antigen enzyme immunoassay was negative, but urine antigen level was >25 ng/mL. He was treated with amphotericin for 2 weeks and transitioned to itraconazole. Mycophenolate was discontinued. After discharge, the patient’s skin nodules and pulmonary findings on serial imaging continued to improve with treatment. His urine blastomyces antigen downtrended and cleared after 15 months of continued therapy.
Discussion
Skin lesions in a kidney transplant recipient should prompt clinical suspicion for opportunistic infections including blastomyces, histoplasma, aspergillus, cryptococcus, nocardia, tuberculous and non-tuberculous mycobacteria. Lesions from blastomyces can appear as raised papules, nodules, or verrucous lesions which can ulcerate over time, and are usually violaceous in color with central areas being lighter due to necrosis. Prompt recognition of such lesions allows for timely initiation of anti-fungal therapy such as in this case, ultimately leading to a good outcome.
(1) Skin findings
(2) Large mediastinal lymphadenopathy