Immunocompromised patients are often some of the sickest patients in the hospital. Dermatologists who focus on inpatient consultations and caring for hospitalized patients are often faced with the gravely ill, severely immunocompromised patient who presents with cutaneous lesions that are a mystery to the primary team and the other involved subspecialty consultants. More often than not these lesions are a sign of an infection, typically one that is potentially lifethreatening. Infections in the immunocompromised host often lead to rapid demise, making early recognition of the infectious process crucial to the patient’s survival. The dermatologist plays a central role in identifying the pathogenic organism, implementing the appropriate therapy and prolonging or saving a life. That is the crux of this book. We have combed the literature carefully and combined what we have read with our experience in caring for these very sick, complex patients to present the cutaneous manifestations of infection in the immunocompromised host.
This textbook centralizes the available literature on the cutaneous manifestations of infection in the immunocompromised host. The book is a collection of well-documented references (confirmed by biopsy and culture) on specific skin lesions of infection that illustrates cutaneous lesions of routine and rare infectious organisms, demonstrates the evolution of skin lesions over time, – with immune reconstitution or with the recovery of neutrophils – and highlights recognizable patterns of infection and likely causes in diff erent clinical settings (human immunodefi ciency virus/acquired immune defi ciency syndrome [HIV/AIDS] vs. post solid organ transplantation vs. neutropenia post chemotherapy vs. bone marrow recovery post hematopoietic stem cell transplantation).
We have given particular attention to the pattern of disease produced by routine and opportunistic pathogens to simplify the expanding list of infectious disease possibilities and recognize the most likely organism for a given clinical situation (e.g., fever, pneumonia and rash or fever, meningitis and rash). Starting with the skin lesion (e.g., acral hemorrhagic bullae or subcutaneous nodules), we present an evidence-based tiered diff erential diagnosis based on a literature review, well-documented case reports and the probability of a specific organism manifesting as a specific pattern of infection in the immunocompromised patient. This approach to skin lesions in the immunocompromised host has resulted in a unique textbook with bold illustrations that can be used as a bedside guide for diagnosis.
The text has been thoroughly updated and expanded since the first edition to refl ect emerging trends in infectious organisms that cause disease in each subgroup of immunosuppressed patients.
A new chapter discussing the role of viruses in potentiating malignancies in the immunocompromised patient has been added. The collection of images presented here is a rare and precious anthology gathered from our work in the “hospital trenches.”