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Böbrek Nakli Sonrası Gelişen Subkutanöz Zigomikoz Enfeksiyonunun Başarılı Bir Şekilde Tedavisi

Successful Treatment of Deep Cutaneous Zygomycosis Developing Early After Renal Transplantation

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DOI: 
DOI 10.5262/tndt.2011.1001.15

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Abstract (2. Language): 
A 25-year-old male patient with end-stage renal disease due to chronic pyelonephritis who had undergone renal transplantation was admitted 20 days after the operation with complaints of nausea, vomiting and darkening in the skin of the transplantation site. A 30x30 cm area of skin at the transplantation site in the left inguinal area was dark colored and of necrotic appearance. Gram-negative and gram-positive bacilli were observed in the gram stain of the material taken from the lesion through thin needle aspiration. Surgical debridement of necrotic tissues at the lesion site was performed. There were fungi with bacterial groups and branched rough hyphae infiltrating the necrotic lipid and connective tissue. The venous wall was under the invasion of these fungi hyphae in the histopathological examination of the debridement material and a diagnosis of subcutaneous zygomycosis was established. Amphotericin B was administered for 14 days at a cumulative dose of 625 mg. The skin defect at the left lower quadrant was closed by placing a graft. The patient no longer required dialysis after two weeks of hospitalization. He was discharged 48 days later with total recovery of the lesion site and a serum creatinin level of 2 mg/dL, under treatment with cyclosporine 400 mg/day and prednisolone 20 mg/day.
Abstract (Original Language): 
Kronik pyelonefrite bağlı son dönem böbrek yetmezliği nedeniyle renal transplantasyon yapılmış 35 yaşındaki erkek hasta, operasyondan 20 gün sonra mide bulantısı, kusma, transplantasyon bölgesi derisinde esmerleşme ile başvurdu. Sol inguinal bölgede, transplant sahasında 30x30cm’lik bölgede deride nekrotik görünümlü kararma görüldü. İnce iğne aspirasyonu ile alınan materyalin gram boyamasında gram negatif ve gram pozitif basil izlendi. Daha sonra nekrotik doku debritmanı yapıldı ve nekrotik yağ ve bağ dokusunu infiltre eden mantar ile birlikte bakteri kolonizasyonu ve dallı hifalar görüldü. Debritman materyalinden yapılan histopatolojik incelemede mantar hifalarının invazyon yerinin altında venöz duvarın görülmesiyle subkutanöz zygomycosis tanısı konuldu. 14 gün boyunca kümülatif olarak 625 mg Amfoterisin B tedavisi verildi. Sol alt kadrandaki deri defekti de greft ile kapatıldı. Hasta 2 hafta hastanede yattıktan sonra diyaliz tedavisine ihtiyacı kalmadı. Hasta lezyon sahasının tamamen iyileşmesinden 48 gün sonra, 400 mg/gün siklosporin ve 20 mg/gün prednizolon tedavisi ile kreatinin seviyesi 2 mg/dL düzeyine gelince taburcu edildi.

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