bluuebunny/crossref_metadata_2025_split huggingface dataset:
BI04 Cutaneous cryptococcosis: a post-transplant cat among the pigeons
Authors: Patel Majeeda , Cernova Jeva , Mabayoje Diana , Rajakariar Ravindra , Warrens Anthony , Harwood Catherine 
Published: June 2023

Abstract
Cryptococcosis is an infection caused by the encapsulated yeasts Cryptococcus neoformans and Cryptococcus gattii, which are opportunistic pathogens that mainly affect immunocompromised individuals. Infection is primarily by inhalation and causes pulmonary disease; haematogenous dissemination may affect other organs, particularly the central nervous system, with 10% of disseminated cryptococcosis affecting the skin. Primary cutaneous cryptococcosis due to direct skin inoculation is less common and rarely disseminates. We describe a kidney transplant recipient with disseminated cryptococcosis who presented with skin lesions in the early post-transplant period. As previously observed in a transplant patient with primary cutaneous cryptococcosis under our care, we propose that a history of close contact with urban pigeons was the source of infection. A 48-year-old man who had been transplanted in 2014 presented in May 2022 with a 3-cm-diameter, well-demarcated ulcer on his right shoulder which had been slowly enlarging over 6 weeks in close proximity to his recent COVID-19 vaccination site. Swab was positive for C. neoformans, serology was positive for cryptococcal antigen, chest X-ray showed a 14-mm nodule in the right lung and magnetic resonance imaging of the brain was normal. He was admitted by the transplant team and treated for presumed disseminated cryptococcal infection with intravenous AmBisome® and flucytosine for 2 weeks, and subsequently oral fluconazole. In view of his atypical presentation, we directly questioned him about previous skin disorders and possible sources of infection. It emerged that 6 months earlier, he had noticed multiple lesions on his legs but did not report this as they spontaneously resolved. Mobile phone images showed 0.5–1-cm umbilicated, red–purple nodules consistent with possible primary cutaneous cryptococcosis. We discovered that his balcony was covered in pigeons and their droppings, and he had unsuccessfully asked his local council to provide bird netting. This was the most likely source of his infection, although it is uncertain whether his skin involvement was primary, secondary or both, due to ongoing pigeon exposure. A 54-year-old female patient under our care who had previously presented 3 months post-transplant with extensive noduloulcerative umbilicated lesions confirmed on biopsy to be primary cutaneous cryptococcosis also had close contact with pigeons and their droppings in the immediate post-transplant period. The incidence of cryptococcosis in immunocompromised patients is increasing and cutaneous involvement may be the first manifestation of disseminated disease. The clinical spectrum of skin lesions is highly polymorphic, making diagnosis challenging. However, it should be considered in immunocompromised patients presenting with atypical skin lesions, particularly in the early post-transplant period.
BI07 Outcomes of oral squamous cell carcinoma following haematopoietic stem cell transplantation
Authors: Zaki Faaris , Shephard Martina , Danby Robert , Davies James , Pawson Rachel , Peniket Andy , Matin Rubeta 
Published: June 2023

Abstract
Haematopoietic stem cell transplant (HSCT) recipients are at increased risk of malignancies, including cancers of the oral cavity, with a reported observed-to-expected ratio of 10.7, accounting for 14% of all solid tumours following HSCT. We report 10 cases of oral squamous cell carcinoma (SCC; 2016–2022) in HSCT recipients from a single tertiary centre [nine men and one woman; median age at diagnosis 52 years (range 27–66)]. Thirty per cent were ex-smokers and 10% current smokers. Prior to HSCT, 50% had reduced intensity conditioning, 40% had myeloablative conditioning and 10% had both. Eighty per cent were recipients of sibling allografts and 20% were recipients from matched unrelated donors. Ninety per cent had a history of chronic graft-versus-host disease (GVHD), with affected sites including the mouth (n = 6), skin (n = 6), eyes (n = 5), lungs (n = 4), kidneys (n = 3) and liver (n = 1). Forty per cent had active severe manifestations of oral GVHD. Treatments used for oral GVHD included topical immunosuppression (n = 5), oral immunosuppression (n = 6) and extracorporeal photopheresis (ECP; n = 2). Median latency from HSCT to oral SCC diagnosis was 10 years (range 4–22). At the time of SCC diagnosis, 20% were not taking immunosuppressants, 20% were being treated with topical corticosteroids and 50% with oral immunosuppression, and one patient was recently treated with ECP. Examination findings at SCC diagnosis included induration, ulceration, tenderness, bleeding, hyperkeratosis, speckling and lymphadenopathy (n = 1). Fifty per cent were asymptomatic. In 40% of cases, a previous biopsy showed hyperplastic or dysplastic changes. The commonest sites of SCC were the tongue (n = 4) and buccal mucosa (n = 3). The disease stage (TNM) at presentation ranged from T1N0M0 to T4N2M0. Sixty per cent of cases were T3 or T4 and 40% had nodal involvement. Management included radical surgical resection in 90% of cases; 10% received adjuvant radiotherapy and 10% chemoradiotherapy. One patient with an SCC on the lower lip underwent resection using Mohs micrographic surgery. Median duration of follow-up for the cohort was 0.8 years (range 0.4–5.7) with a 50% mortality rate. In our cohort, median survival following oral SCC diagnosis was 0.8 years (range 0.4–5.0) and SCC-specific mortality was 30% (n = 3). We report the largest UK case series, to the best of our knowledge, of oral SCC post-HSCT. The data show a long latency from HSCT to the onset of oral SCC, highlighting the importance of regular, active oral surveillance by haematologists, dermatologists, oral specialists and dentists. This follow-up is recommended irrespective of the severity of GVHD and length of iatrogenic immunosuppression. Intensive surveillance is indicated in groups at higher risk with a history of chronic oral GVHD.
BI10 ‘I never thought it would happen to me’. Photoprotection and skin cancer education: a qualitative study of the experiences of Irish postrenal transplant patients. Why the ‘personal touch’ is so important
Authors: Griffin Laoise , Laing Mary , O’Reilly Pauline , Griffin Matthew 
Published: June 2023

Abstract
Renal transplant recipients (RTRs) are at an increased risk of skin cancer (SC), especially squamous cell carcinoma (SCC). As the number of successful transplant recipients increases, pressure on dermatology services increases. The focus has shifted from simply screening RTRs for SC to implementing preventive measures, including SP education programmes. Sun exposure is a modifiable risk, yet RTRs are known to adopt sun-protective (SP) behaviour only partially. There is a dearth of research on why this is. We performed an in-depth qualitative study using inductive thematic analysis of 14 semistructured interviews of seven male RTRs to assess the impact of the current SP education and explore their current SP behaviour. Participants included those with SC, premalignant skin disease and no SC. Two themes were constructed. Each theme had two subthemes. The first theme was ‘Timing it Right—Skin cancer information’, with the subthemes of ‘A time of great emotion’ and ‘Providing knowledge—learning needs differ’. Choosing a suitable time to impart information on SC is important. Immediately prior to and on receiving a kidney transplant was not felt by patients to be the most appropriate time. Most felt unable to consider perceived future risks to their health during this critical period. When delivered, recipients expressed preference for an ‘in-person’ approach with supplementary information available (online and written). The second theme was ‘The person within the patient’, with the subthemes of ‘What matters to the patient’ and ‘Authentic engagement’. It is important to see the person within the patient. Each brought with them different worries and requirements, sometimes feeling guilty when expressing them as they had received a new ‘gift of life’. Participants knew what constituted a good health education experience for them. The healthcare professional who was compassionate and listened was valued and more likely to influence behaviour. Interviewees spoke about the strong bond they form with their renal teams and how they trust them. Misconceptions were also uncovered such as the belief that the Irish sun differed from that experienced abroad and that SP was just for ‘sunny days’. An overriding concern for developing melanoma rather than cutaneous SCC was evident, as was the lack of confidence in ability to self-monitor skin. SC prevention programmes are becoming increasingly well established; our study identified gaps in the knowledge of RTRs and highlighted some key areas and approaches to improve the impact of educational interventions. To maximize the impact, it is important to consider patient perspectives, cultural context and the key role our renal colleagues play in patients’ lives.
Funding: support was received from The City of Dublin Skin and Cancer Hospital Charity (registered Charity Number: 20004620).
BI11 Cutaneous presentation of Kaposi sarcoma following allogeneic haematopoietic stem cell transplantation for myeloma
Authors: McGrath Conn , Thomas Bjorn , Duncan Mhairi , Basu Tanya , Benjamin Reuben , Child Fiona 
Published: June 2023

Abstract
Iatrogenic Kaposi sarcoma (KS) is a relatively frequent occurrence following solid-organ transplants (0–5%), in part due to prolonged immunosuppression. However, its occurrence after haematopoietic stem cell transplantation (HSCT) is rare, with only 15 cases described in the literature. We report a case of KS presenting in the skin of a patient who had received a matched unrelated donor allogeneic HSCT for IgG kappa myeloma. A 55-year-old HIV-negative white man with myeloma underwent an allogeneic HSCT from a matched, unrelated donor following conditioning chemotherapy with fludarabine–melphalan and antithymocyte globulin. Post-transplant, he was maintained on ciclosporin as graft-versus-host disease (GVHD) prophylaxis. On day 14 post-transplant, he developed a widespread eczematous eruption that rapidly evolved into an erythroderma; a skin biopsy was consistent with acute GVHD. He was managed with superpotent topical steroids and a 5-day course of oral prednisolone. He began extracorporeal photopheresis (ECP) on day 33 post-transplant, having failed to respond adequately to systemic steroids. He also completed four cycles of rituximab. Ciclosporin was stopped by day 130 post-transplant. He had completed 14 cycles of ECP by day 139 post-transplant, with resolution of cutaneous GVHD; however, he had developed a rapidly growing solitary dusky-red nodule on his right neck that was excised due to diagnostic uncertainty. Histology revealed a dermal haemorrhagic exophytic vascular tumour composed of lobules and sheets of epithelioid cells with an eosinophilic cytoplasm and pleomorphic nuclei. Immunoperoxidase staining was negative for S100, MNF-116 and AE1/AE3. The same cells were strongly and diffusely positive for the vascular markers CD31, CD34 and ERG. The lesional cells were positive for human herpesvirus (HHV)-8 confirming a diagnosis of Kaposi sarcoma. He subsequently developed a second lesion on his left forearm, despite being off all immunosuppression. A repeat bone biopsy confirmed that he remains in morphological remission from his myeloma. Positron emission tomography–computed tomography has not identified extracutaneous disease. KS following HSCT is rare, but it can be fatal. Skin lesions are the dominant clinical presentation. HHV-8 has an important role in the pathogenesis, and transplant-related KS may occur secondary to reactivation of the virus as a result of significant immunosuppression following HSCT. However, it could also occur as primary infection or be transmitted with donor cells. The outcome of KS after HSCT is variable. A watch and wait strategy can be applied if immune recovery is expected. In our patient, it developed 5 months after HSCT; shortly after immunosuppression had been tapered, he remains well and will be closely monitored for further suspicious lesions.
BI12 The incidence and survival of Kaposi sarcoma using national cancer registry data
Authors: Quaresma Catarina , Lapin Agnieszka , Vernon Sally , Tan Agnieszka , Venables Zoe C 
Published: June 2023

Abstract
Kaposi sarcoma (KS) is a rare soft tissue endothelial neoplasm associated with human herpesvirus (HHV)-8 infection. Four types of KS are recognized, with the majority of cases in the West attributed to HIV-associated KS or, less frequently, to iatrogenic KS caused by systemic immunosuppression. Population-based data on KS epidemiology in England are lacking, with the last published evaluation dating back to the 1980s. More recently, data on KS epidemiology have been included in the National Cancer Registration and Analysis Service’s (NCRAS) ‘Get Data Out’ annual reports, with details published from 2013 to 2019. A nonsignificant reduction in the incidence rate of KS in England was observed from 2013 [0.271; 95% confidence interval (CI) 0.229–0.319] to 2019 (0.222, 95% CI 0.185–0.265; www.cancerdata.nhs.uk/getdataout/kaposi_sarcoma). This figure is slightly lower than the most recent reported crude incidence rates of KS in Europe from 2000 to 2007 (0.28) and significantly lower than that of the USA in 2017 (0.45) and globally in 2020 (0.439) (https://gco.iarc.fr/today/data/factsheets/cancers/19-Kaposi-sarcoma-fact-sheet.pdf). Data from NCRAS show that most cases of KS in England were diagnosed following a general practitioner referral (32.8%), outside the 2-week wait route (15.6%). A noteworthy proportion of cases (17.2%) were diagnosed following an emergency presentation to the emergency department, emergency clinician referrals or acute admissions. The 5-year net survival after the diagnosis of KS was stable at 81.3% (95% CI 73–89.5), 86.8% (95% CI 79.5–94.1) and 79.7% (95% CI 67.2–92.2) for 2013, 2014 and 2015, respectively (www.cancerdata.nhs.uk/getdataout/kaposi_sarcoma). These data provide a useful insight into the epidemiology of this rare cancer; however, it is probable that the true incidence of KS is under-reported, particularly in cases where there is no histological confirmation or reporting of KS on the death certificate, which may be more likely in patients who were HIV positive. Lack of knowledge of the underlying cause for KS is a major limitation. In conclusion, there is a paucity of published data on KS epidemiology in England. Further evaluation of KS subsets, patient demographics and comorbidity at diagnosis is needed to allow a better understanding of differences in the KS incidence in England in comparison with global figures.
BI14 Photoprotection and skin cancer awareness in kidney transplant recipients living with HIV: a single-centre cross-sectional study
Authors: Ali Fatima , Cronin Antonia 
Published: June 2023

Abstract
Kidney transplant recipients (KTRs) are up to 65 times more likely to develop nonmelanoma skin cancers than age-matched general populations. HIV has also been associated with increased skin cancer rates. However, to date, there has been no study evaluating photoprotection and skin cancer awareness in KTRs living with HIV (KTRLHIV).
Using validated photoprotection and skin cancer awareness questionnaires, we evaluated knowledge and practices in KTRLHIV and an HIV-negative KTR cohort, matched for age, sex, ethnicity and years since transplant. KTRLHIV (n = 27) and matched HIV-negative KTRs (n = 25) completed the questionnaires. Thirty-four (65%) were male and 37 (71%) were Black. The average age was 56 years (range 43–74). On average, patients were 7.3 years post-transplant (range 0.7–24). Twenty-two (81%) KTRLHIV vs. 15 (60%) matched HIV-negative KTRs had not seen a dermatologist in the last year. Only 14 (52%) KTRLHIV had received sun protection advice vs. 20 (80%) of the matched KTRs (P = 0.033). There were statistically significant lower rates of overall sunscreen use in KTRLHIV compared with matched HIV-negative KTRs (33% vs. 60%; P = 0.054). Only a small proportion used sunscreen daily (22% vs. 27%), of a sun protection factor &gt; 25 (78% vs. 100%). A strongly positive tetrachoric correlation coefficient of 0.77 indicated that providing photoprotection advice correlates to sunscreen use. Significantly lower rates of photoprotection behaviours were seen in the KTRLHIV compared with HIV-negative KTRs, particularly never avoiding direct sunlight (59% vs. 16%; P = 0.001) and never dressing to protect from the sun (52% vs. 12%; P = 0.002). We have identified statistically significant lower knowledge of photoprotection and skin cancer awareness in KTRLHIV vs. matched HIV-negative KTRs. Lower rates of skin cancer protection advice may have resulted in lower rates of sunscreen use and poorer photoprotection behaviours in KTRLHIV. A dedicated skin cancer awareness education to promote patient-led skin cancer prevention alongside formal dermatology referral is recommended.
BI15 (P16) Cutaneous renal cell carcinoma metastasis with scrofuloderma as the initial presentation of metastatic renal cell carcinoma: a diagnostic challenge
Authors: Kothari Rohit 
Published: June 2023

Abstract
Renal cell carcinoma (RCC) with cutaneous metastasis is uncommon and accounts for approximately 3–5% of metastatic RCC, with an unfavourable prognosis. We present an unusual and difficult case of advanced RCC presenting initially with cutaneous metastasis and scrofuloderma, with identical morphology of the lesions. It also highlights the importance of dermatologists in the early diagnosis and management of such cases. A 50-year-old man presented with gradually progressive, multiple erythematous discharging nodules over the right side of his neck of 3 months’ duration. He described a weight loss of 10 kg, intermittent undocumented fever with headache and two episodes of uninvestigated transient haematuria in the last 6 months. He had received multiple courses of antibiotics without any relief. A skin biopsy and immunohistochemistry confirmed cutaneous RCC metastasis with a primary advanced metastatic left RCC, involving the brain as well. A total left nephrectomy was done and he was started on lenvatinib, everolimus and radiotherapy, following which there was suboptimal response and he started developing similar nodular lesions over the left axilla and chest wall, and a puckered crusted plaque over the left lateral abdomen 1 week post-treatment. Follow-up at 8 weeks revealed a significant response in the neck lesions; however, the new lesions on the left side did not respond, following which a dermatology consultation was sought again. A skin biopsy from the new lesions confirmed scrofuloderma. Tissue polymerase chain reaction and culture were positive for mycobacterium tuberculosis. He was diagnosed as having scrofuloderma and started on daily isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months followed by daily isoniazid and rifampicin for 4 months. Follow-up at 6 months revealed well-healed lesions, and the systemic symptoms and discharge had abated. The cutaneous metastatic lesions had also healed completely. Here, we present an interesting case of cutaneous RCC metastasis with coexisting scrofuloderma as the initial manifestation of an advanced RCC, posing a diagnostic challenge due to similar morphology. On this background, a recurrence of cutaneous metastasis was the first possibility considered for the new skin lesions. The delay in diagnosis led to significant morbidity in our patient, emphasizing the role of early dermatology consultation in the management of such cases. A high index of suspicion for conditions masquerading as cutaneous metastasis, as well as a lower threshold for skin biopsy, may improve the prognosis dramatically.
BI16 (P41) An emerging role of interferon-targeted therapy for the treatment of cutaneous systemic lupus erythematosus: a prospective real-world evaluation of anifrolumab for refractory cutaneous lupus
Authors: Carter Lucy , Wigston Zoe , Laws Philip , Vital Edward 
Published: June 2023

Abstract
Cutaneous lupus erythematosus (CLE), particularly discoid lupus erythematosus (DLE), is frequently unresponsive to standard therapies, including antimalarial and immunosuppressive therapies. Recent evidence has identified the importance of type-1 interferon (IFN-1) in the pathogenesis of disease. Anifrolumab is a monoclonal antibody that targets IFN-1 and has been licensed for the treatment of systemic lupus erythematosus (SLE). It is unclear which clinical subtypes of CLE are associated with an IFN-1 signature and may be responsive to anifrolumab therapy. We sought to evaluate the efficacy of anifrolumab on (i) DLE and (ii) rituximab-refractory CLE; and (iii) to compare IFN-specific biomarkers and (iv) early and late immunophenotypic and clinical responses. Anifrolumab was available through an early access to medicines scheme. Patients with SLE for whom the phenotype was predominantly cutaneous were treated with anifrolumab 300 mg intravenously every 4 weeks. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Dermatology Life Quality Index (DLQI) were reported. Seven patients were enrolled (five with DLE, one with chilblain and one with subacute CLE). All patients were female (median age 46 years; median disease duration 17 years). The median number of failed therapies was six: rituximab in six, belimumab in two and thalidomide in four patients. Four patients required long-term oral prednisolone &gt; 10 mg daily. Median baseline CLASI activity score was 17 and DLQI was 16/30. Median CLASI score reduced after 4 weeks to 6 (range 0–13; P = 0.016) with a median decrease from baseline of 60% (range 19–100%), which was maintained at 6 months. Clinical responses were associated with significant improvements in DLQI (P &lt; 0.001) and EQ-5D visual analogue scale (P = 0.002) by 3 months. All patients had a marked suppression of IFN-stimulated genes at 4 weeks (mean difference 2.92; P &lt; 0.01). Treatment was generally well tolerated with the exception of one patient who had shingles complicated by sensorineural hearing loss while on anifrolumab and prednisolone &gt; 15 mg daily. This required prolonged aciclovir for effective management. This case series highlights the potential role for anifrolumab in managing treatment-resistant CLE with particular responses observed in DLE and chilblain lupus. The need for enhanced awareness of viral infections, particularly varicella-zoster virus, needs to be considered in higher-risk patients.