Primary cutaneous cryptococcosis (original) (raw)
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.
Primary cutaneous cryptococcosis and a surprise finding in a chronically immunosuppressed patient
JMM Case Reports, 2014
Introduction: Primary cutaneous cryptococcosis is a rare form of cryptococcosis occurring after direct inoculation of Cryptococcus spp. yeast cells through skin injury and equally affects immunocompetent and immunocompromised individuals. We report a case of a 61-year-old man who presented with an 8-month history of an ulcerative lesion on a finger, which was refractory to antimicrobials, following injury with a plant thorn. The patient had a medical history of myasthenia gravis and had been undergoing treatment with pyridostigmine and intermediate doses of prednisolone for more than 30 years. A skin-lesion culture was positive for Cryptococcus neoformans var. neoformans, which was molecularly confirmed and typed as serotype D, mating-type a, genotype AFLP2/ VNIV. Histopathology revealed a diffuse type of inflammation, with many yeasts consistent with Cryptococcus spp. The serum cryptococcal antigen was positive at a titre of 1 : 32. Radiological investigation excluded disseminated disease but revealed the incidental presence of a clear cell renal cell carcinoma. The tumour was considered to be an additional factor of immunosuppression and could justify the histological findings. The patient was treated with 200 mg fluconazole twice daily, underwent surgical removal of the mass and received treatment with sunitinib, a receptor protein-tyrosine kinase inhibitor. At the 4 month follow-up, he had a remarkable clinical improvement. A year after, he remained symptom free and tolerated the antitumour therapy well. The patient presented here had no evidence of a disseminated cryptococcal infection despite two concurrent causes of cellular immunity defect and a positive antigen titre.
Primary Cutaneous Cryptococcosis Caused by Cryptococcus neoformans in an Immunocompetent Patient
Journal of Clinical Medical Research, 2023
Background: Primary Cutaneous Cryptococcosis (PCC) is an uncommon disease restricted to cutaneous tissues caused by Cryptococcus spp. Case-report: We report a PCC case in a patient without any underlying disease. A 44-year-old man from Southern Brazil was referred to the hospital with 3-year recurrent skin lesions. A biopsy showed typical rounded and encapsulated blastoconidia typical of Cryptococcus and C. neoformans was identified in culture. Treatment with fluconazole (600 mg/day) was prescribed with improvement of the lesions. During the follow-up a self-reported interruption of treatment was detected and after 1 year of treatment, complete clinical cure was not yet achieved. Conclusion: This uncommon case reinforces the importance of mycologic examinations for correct diagnoses.
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.
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.
Systemic cryptococcosis in an immune-competent child
Journal of infection and public health, 2017
Crytococcus neoformans is an encapsulated yeast that frequently affects immune-compromised patients, although increasingly being detected in the immune-competent host as well. We report a case of disseminated cryptococcosis in a young child in whom no immune deficiency was yet identified. A 4-year-old child presented with high-grade fever, intermittent abdominal pain and generalized skin eruptions for the past two months. He had pallor, firm lymphadenopathy, skin lesions with scarring and firm hepatosplenomegaly. Magnetic resonance imaging of brain and bone-marrow aspiration were normal. Fine-needle-aspiration-cytology of cervical lymph nodes demonstrated Cryptococcus. Serum latex-agglutination test showed a positive titer (1:256). Cryptococcus culture was sterile. The patient received intravenous liposomal amphotericin-B and oral flucytosine for 8 weeks followed by oral fluconazole. Disseminated cryptococcosis with involvement of reticuloendothelial and dermatological systems is ra...
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