Cutaneous cryptococcosis due to Cryptococcus gattii in a patient on chronic corticotherapy

Abstract

RESUMOCryptococcus gattii é agente causador de uma micose endêmica que afeta principalmente os pulmões e o sistema nervoso central de pacientes imunocompetentes em regiões tropicais e subtropicais do globo. Relato de caso. Um paciente de 66 anos, portador de doença pulmonar obstrutiva crônica, não infectado pelo vírus HIV, em corticoterapia sistêmica prolongada, desenvolveu extensa ulceração do antebraço esquerdo, associada a adenomegalia supraclavicular ipsilateral, em conseqüência à infecção por Cryptococcus gattii. O paciente foi tratado com fluconazol 400mg/dia durante 8 meses, obtendo resolução completa da lesão. Este caso enfatiza que, ainda que raramente, C. gattii pode causar infecção cutâneo-linfática oportunista, em paciente imunocomprometido pelo uso sistêmico de corticosteróides vivendo na região sudeste do Brasil. Palavras-chaves: Criptococose cutânea. Doença pulmonar obstrutiva crônica. Corticoterapia. Cryptococcus gattii. ABSTRACTCryptococcus gattii causes a form of endemic mycosis that most commonly affects the lungs and central nervous system of immunocompetent patients living in tropical and subtropical areas of the world. Case report. A 66-year-old man who had chronic obstructive pulmonary disease without HIV infection and had been on systemic corticotherapy for several years developed extensive ulceration of the left forearm that was associated with ipsilateral supraclavicular adenomegaly, consequent to infection with Cryptococcus gattii. The patient was treated with fluconazole 400mg/day for eight months, which led to complete healing of the lesion. This case emphasizes that, although rare, C. gattii may cause opportunistic cutaneouslymphatic infection in patients living in the southeastern region of Brazil who are immunocompromised through chronic corticotherapy.

Cryptococcus gattii Infections

“…Primary skin involvement is rare in Australia and British Columbia (130,198). Skin lesions may herald disseminated disease, with papules, nodules, ulcers, or cellulitis occurring typically on the face and neck; these patients may be immunocompromised (236,256,290). Musculoskeletal infection has been reported.…”

Zoonoses Surveillance in Italy (2000-2009): Investigation on Animals with Neurological Symptoms

“…In natural conditions the immune response in humans provides resistance to infection, but in 85% of cases cryptococcosis affects the lungs and the CNS in debilitated patients within settings such as AIDS, tuberculosis, leukaemia and lymphoma (Summers et al, 1995;Kerl, 2003;Chuck et al, 1989;Nagrajan et al, 2000;Fernandes et al, 2000). C. gattii has also been reported in association with skin lesions in patients undergoing prolonged corticosteroid therapy (Bellissimo-Rodrigues et al, 2010). Even in the cat prolonged corticosteroid use may aggravate the infection, but there are no data demonstrating whether immunosuppressive diseases such as FIV and FeLV may predispose individuals to cryptococcosis (Gerds-Grogan et al, 1997;Kerl, 2003).…”