Cryptococcosis presenting as upper limb cellulitis and ulceration: A case series

Fallah, Haady; Watson, A. Gordon; Henderson, Christopher; Woodford, Phillip; Bothman, John; McCrossin, Ian

doi:10.1111/j.1440-0960.2011.00820.x

Cited by 6 publications

(15 citation statements)

References 14 publications

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“…It can also occur via local inoculation . The skin is the third most commonly affected organ in disseminated cryptococcosis . Primary cutaneous cryptococcal infection usually presents with solitary lesions resembling cellulitis, ulceration or whitlow located on unclothed areas, whereas disseminated cryptococcosis presents with scattered umbilicated papules resembling molluscum contagiosum .…”

Section: Discussionmentioning

confidence: 99%

An unusual cause of cutaneous ulceration

Wlodek

Bovill

et al. 2017

Clin Exp Dermatol

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A 71-year old white man presented with a 2-month history of bilateral forearm ulceration, which was managed with dressings by his primary care practitioner. On direct questioning, he described 'bumps' forming under the skin, which would then 'crust over and break down'. He had a history of bronchiectasis and chronic obstructive pulmonary disease requiring home oxygen. He had undergone successful fullthickness forearm skin grafts 10 months earlier for bilateral necrotic cellulitis. He was on a number of regular medications, which included prednisolone 15 mg daily, which he had been taking for many years.On physical examination, painful superficial ulceration was seen, affecting both forearms and extending onto the dorsal hand. The ulcers were noninflammatory and did not have an undermined edge (Fig. 1). Proximal to both elbows were three nodules, one of which was ulcerated. An incisional biopsy was taken from one of these. Histopathological findingsSkin biopsy showed surface ulceration and a diffuse dermal infiltrate of histiocytes, neutrophils and lymphocytes. Most histiocytic intracellular vacuoles contained pale basophilic bodies (Fig. 2).Blood tests revealed neutrophilia (10.3 9 10 9 /L; normal range 1.5-7 9 10 9 /L) and lymphopenia (0.61 9 10 9 /L; 1.5-4 9 10 9 /L), HIV antibody was negative, and there was a stable IgG lambda paraprotein at 1 g/L with no evidence of immune paresis. Direct microscopy of the tissue specimen stained with the optical brightener Calcofluor revealed multiple spherical budding organisms (Fig. 3a). Indian ink stain highlighted encapsulated structures (Fig. 3b). The tissue was cultured on Sabouraud glucosepeptone agar at 37°C, and colonies grew after 48 h (Fig. 3c).What is your diagnosis?

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Section: Discussionmentioning

confidence: 99%

An unusual cause of cutaneous ulceration

Wlodek

Bovill

et al. 2017

Clin Exp Dermatol

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“…2,8,15 However, direct inoculation is a possible route, which causes primary cutaneous cryptococcosis (PCC). 11 A history of trauma is the most frequently reported risk factor to provide a portal of entry, and foreign body puncture and animal-related trauma are the most common related causes. Patients with hobbies or occupations that put them at risk of injuries with exposure to soil, dust, wood sticks or debris, or bird droppings are at the greatest risk of PCC.…”

Section: Discussionmentioning

confidence: 99%

“…16,21,22 In immunocompetent patients, the Infectious Disease Society of America guidelines recommend treating cryptococcal CNS infection or dissemination with amphotericin B (0.7-1 mg/kg/day) plus flucytosine (100 mg/kg/day) for at least 4 weeks, followed by consolidation therapy with fluconazole (400-800 mg/day) for a minimum of 8 weeks and maintenance therapy with fluconazole (200 mg/day) for 6-12 months. 11,21,22 As for pulmonary disease, fluconazole 400 mg daily for 6-12 months is recommended in mild to moderate disease. The regimen differs in severe or progressive disease, which is the same as treating CNS involvement.…”

Section: Discussionmentioning

confidence: 99%

“…The regimen differs in severe or progressive disease, which is the same as treating CNS involvement. 11,21,22 Secondary cutaneous cryptococcosis is treated in a manner similar to that of CNS infection, whereas fluconazole 400 mg daily for 6-12 months is recommended to treat PCC in an immunocompetent host. 11,21,22 However, a short-term (2 weeks) course of fluconazole treatment (200 mg daily) has also proven to be effective in PCC.…”

Section: Discussionmentioning

confidence: 99%

“…11,21,22 Secondary cutaneous cryptococcosis is treated in a manner similar to that of CNS infection, whereas fluconazole 400 mg daily for 6-12 months is recommended to treat PCC in an immunocompetent host. 11,21,22 However, a short-term (2 weeks) course of fluconazole treatment (200 mg daily) has also proven to be effective in PCC. 16 The clinical manifestations in the current study included a circumscribed skin lesion in an unclothed area without evidence of dissemination or cellular immunity deficiency.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Primary cutaneous cryptococcosis in an immunocompetent man: A case report

Lü¹,

Wu²,

Hong³

2013

Dermatologica Sinica

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a b s t r a c tCutaneous cryptococcosis usually develops secondary to hematogenous spread in immunocompromised hosts. Primary cutaneous cryptococcosis (PCC) is a rare condition characterized by localized skin eruptions and positive culture for Cryptococcus neoformans but without dissemination to the internal organs. Herein, we describe a typical case of PCC in an immunocompetent male who presented with a 1-month history of scattered erythematous indurated papules and plaques on his arm and without fever. The histology of his skin, tissue culture, and multiplex polymerase chain reaction (PCR) confirmed cutaneous cryptococcal infection by C neoformans var. neoformans. After extensive work-ups showed no evidence of systemic dissemination or underlying cellular-immunity deficiency, the diagnosis of primary cutaneous cryptococcosis was made. Treatment with fluconazole 400 mg daily for 14 days followed by 200 mg daily for another 14 days led to complete resolution of the skin lesions, and subsequent follow-up showed no signs of relapse.

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Edematous Erythema, Subcutaneous Plaques, and Severe Pain in the Lower Extremities in an Immunocompromised Patient

Ding

Fang²

2013

JAMA

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Cryptococcosis presenting as upper limb cellulitis and ulceration: A case series

Cited by 6 publications

References 14 publications

An unusual cause of cutaneous ulceration

An unusual cause of cutaneous ulceration

Primary cutaneous cryptococcosis in an immunocompetent man: A case report

Edematous Erythema, Subcutaneous Plaques, and Severe Pain in the Lower Extremities in an Immunocompromised Patient

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