Primary Cutaneous Cryptococcosis Caused by Cryptococcus neoformans in an Immunocompetent Patient (original) (raw)
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A case of primary cutaneous cryptococcosis
European Journal of Clinical Microbiology & Infectious Diseases, 1997
The case of a 77-year-old man in whom a large digital ulcer with undermined edges was due to cutaneous infection by Cryptococcus neoformans variety neoformans serotype D, probably following direct inoculation, is reported. Long-term steroid treatment for chronic obstructive pulmonary disease may have been a risk factor. A 12-day course of intravenous amphotericin B at a cumulative dose of 750 mg, followed by oral fluconazole at a daily dose of 600 mg for six weeks, resulted in healing of the skin lesion. Manifestations of primary cutaneous cryptococcosis in immunocompetent or immunocompromised patients are reviewed.
Journal of Infectious Diseases & Therapy, 2017
Cryptococcus neoformans is opportunistic encapsulated yeast that represents the most frequent cryptococcal species found in humans. It can cause three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and cutaneous cryptococcosis. Cutaneous cryptococcosis may represent the dissemination of a systemic infection (especially from nervous or pulmonary primary site of infection) or may be the only localization, due to a direct inoculation into the skin, because of a traumatic injury. Primary cutaneous cryptococcosis (PCC) is rare and mainly affects elderly patients, from rural areas, with history of cutaneous injuries and activities predisposing wounds or exposure to bird droppings. Immunosuppression may be a predisponing factor. The most utilized treatment is fluconazole, but often, especially for ulcers or deep wounds; surgery is required for complete tissues repair. Herein, we present a case of PCC in an immunosuppressed patient, with destroying ulcers involving deep tissues, completely resolved after fluconazole treatment, without surgical intervention.
Postepy Dermatologii I Alergologii, 2020
Due to constantly growing population of immunocompromised patients the fungi became a widespread threat to modern medicine. HIV carriers, solid organ transplant recipients constitute most of those patients. Cryptococcosis is a frequent cause of life-threatening infections, affecting mostly immunosuppressed patients. This article presents current knowledge on cryptococcal infections, including epidemiology, clinical aspects, diagnosis and recommended treatment. In reference to our patient, who developed a disseminated and fulminant subtype of the disease, we wanted to underline the need to examine patients thoroughly. The highest aim of those measures would be to avoid lethal consequences.
Primary cutaneous cryptococcosis caused by Cryptococcus gattii in an immunocompetent host
Medical mycology : official publication of the International Society for Human and Animal Mycology, 2011
This paper presents the case of a 75-year-old Brazilian man who developed inflammatory skin lesions with nodules and ulcerations on the right forearm after an injury caused by handling barbed-wire and Eucalyptus spp. logs. Histopathological assessment of the lesions showed granulomatous processes with yeasts similar to Cryptococcus spp. Tissue fragments yielded yeasts when cultured that were identified as Cryptococcus gattii VGII through biochemical reactions and URA5-RFLP genotype. No evidence of systemic involvement or any underlying immunosuppressive diseases were identified, which supported the diagnosis of primary cutaneous cryptococcosis. After 5 months on therapy with high fluconazole doses, the skin lesions had fully healed.
Primary cutaneous cryptococcosis
Mycopathologia, 1986
A 7-year-old boy, without apparent underlying disease, but with a non-specific failure in his cellular immunity, developed a cutaneous lesion on the left retroauricular area with spontaneous healing. Mycologic study revealed Cryptococcus neoformans, a capsule deficient strain, as the etiologic agent.
Anais Brasileiros de Dermatologia, 2016
Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs-such as the central nervous system and the skin-can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature.
Dermoscopic observations in disseminated cryptococcosis with cutaneous involvement
Journal of The European Academy of Dermatology and Venereology, 2017
A 26-year-old female patient with a history of intravenous drug abuse, diagnosed with acquired immunodeficiency syndrome (AIDS) 6 months before. AIDS defining disease was Pneumocystis jiroveci pneumonia. The patient presented with severely decreased CD4 cell count of 7 cells/mm 3 and relatively low HIV viral load of 281 copies/mL. Shortly after initiation of antiretroviral therapy (ART), was diagnosed with disseminated cryptococcosis with central nervous system and skin involvement. Initial cutaneous presentation was a solitary tumour of the chin, covered with a necrotic crust. After 2 weeks of induction treatment with amphotericin B and flucytosine, eradication of C. neoformans from central nervous system was confirmed with negative cerebral fluid culture. Improvement in neurological condition and partial regression of the skin tumour was observed. Consolidation therapy with fluconazole (400 mg per day) was recommended for 8 weeks, followed by secondary prophylaxis with fluconazole (200 mg per day), according to European AIDS Clinical Society Guidelines. 1 Six months later the patient was readmitted to the hospital due to severe headache, fever and vomiting with concomitant facial skin lesions (Fig. 1a). Dermoscopy revealed the presence of white structureless areas with or without linear irregular and branched vessels of different size, surrounded with yellow structureless yellowish halo (Fig. 1b-e). Based on laboratory investigations (increase of CD4 cell count of 171 cells/mm 3 , negative microbiological examination of cerebrospinal fluid) and magnetic resonance imaging of central nervous system, Cryptococcal Immune Reconstitution