We report a kidney transplant recipient with severe skin- and soft-tissue infection mimicking necrotising fasciitis. Patient failed to respond to empirical antibiotic therapy for presumed bacterial cellulitis. Culture of aspirate from the wound and tissue samples revealed Cryptococcus neoformans. No signs of systemic cryptococcal infection were found. After antifungal treatment and surgical intervention, complete healing was achieved. Clinical and microbiological characteristics of this patient are discussed. Our case indicates that primary cutaneous cryptococcosis must be included in the differential diagnosis of severe cellulitis in solid organ transplant recipients not responding to broad-spectrum antibiotic regimens. In our case, prompt diagnosis and treatment could dramatically modify the outcome.

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Cutaneous myiasis is a temporary parasitic infestation of the skin of human and other vertebrates by fly larvae, primarily species of the flies Dermatobia and Cordylobia. In Central and South America cutaneous myiasis is mainly caused by the larvae of Dermatobia hominis; in Africa it is mostly due to the larvae of Cordylobia spp. We describe a case of cutaneous myiasis in a family who returned to Slovenia from a three-week trip to Ghana. The parasites, in tumor-like swellings about 1-2 cm in diameter and 0.5-1 cm high, were removed from the back of the 48-year-old man, the nose, shoulder and wrist of his 47-year-old wife, and the back of their 14-year-old daughter. The parasites were identified as larvae of the fly C. anthropophaga. After removal of the larvae, which were oval-shaped and about 8 mm long, the lesions healed in two weeks without further treatment. Human cases of cutaneous myiasis are most probably underreported because many remain undiagnosed or unpublished. Because of increasing travel to tropical and subtropical areas, clinical and laboratory staff will need to be more alert to the possibility of Cordylobia myiasis in patients with furuncle-like lesions, particularly in individuals who have recently returned from tropical Africa.