Labial ecthyma gangrenosum in an immunocompromised infant with leukemia: heightening awareness for the urologist.

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas aeruginosa sepsis. EG generally occurs in immunocompromised hosts, such as patients with severe neutropenia. EG presents as erythematous, hemorrhagic, or necrotic macules or plaques, most commonly in the perineal or gluteal areas, but can occur elsewhere. EG is a dermatologic emergency in immunocompromised patients and should be included in the differential diagnosis when urologists are asked to evaluate perineal lesions. We describe the case of a highly immunocompromised infant with labial EG to highlight the importance of prompt clinical diagnosis and of multidisciplinary medical and surgical management.

Are hepatitis C-positive allografts in simultaneous pancreas-kidney transplantation underutilized?

BACKGROUND: A recent review reported that recipient HCV infection had no significant impact on acute rejection rates or patient survival in SPKT but the utilization of HCV(+) organs was negligible. Using the UNOS database, we sought to determine utilization rates for HCV(+) allografts in Simultaneous Pancreas-Kidney Transplantation (SPKT. MATERIAL/METHODS: The Organ Procurement and Transplant Network / United Network for Organ Sharing database was employed to obtain information regarding HCV(+) and HCV-negative (HCV(-)) SPKT recipients and the disposition of donor pancreata. RESULTS: Between 2000 and January 2011, 702 of 25,904 donors (2.7%) were HCV(+) and met otherwise ideal criteria. We identified 16 patients who received HCV(+) organs for SPKT between 1995 and 2010. Four had kidney allograft losses secondary to chronic rejection. Six had pancreatic allograft losses: one due to pancreatitis, one to infection, one to chronic rejection, one to acute rejection and two to graft thrombosis. None of the sixteen patients were subsequently listed for liver transplantation. Meanwhile, 702 HCV(+) donors between the age of 14 and 40 with a BMI less than 30 were identified. During that time period, only 8 simultaneous pancreas-kidney transplants using HCV(+) donor organs occurred. Therefore, 694 HCV(+) pancreata were not utilized for SPKT in that time span. CONCLUSIONS: 16 patients have undergone SPKT with HCV(+) organs. Aggressive use of HCV(+) organs for SPKT could potentially lead to earlier transplantation for HCV(+) recipients and allow HCV(-) organs to be available more quickly for HCV(-) recipients additional research of this topic is warranted.