Cutaneous cryptococcosis in a diabetic renal transplant recipient

Abstract

A diabetic renal transplant recipient with cellulitis caused by Cryptococcus neoformans, serotype A, is described. The diagnosis was based on the demonstration of capsulated, budding yeast cells in the aspirated material and tissue from the cellulitic lesion and isolation of the aetiological agent in culture. The isolate formed well-developed capsules in the brain tissue of experimentally infected mice and produced cherry-brown colonies on niger seed medium. The patient's serum was positive for cryptococcal antigen (titre 1 : 4) with no other evidence of systemic infection. He was successfully treated with AmBisome, followed by fluconazole, resulting in the complete resolution of cellulitis and disappearance of the cryptococcal antigen. This report underscores the fact that patients with cutaneous cryptococcosis should be thoroughly evaluated, as it may be the first manifestation of a systemic disease. Prompt diagnosis and treatment are important to improve survival.

Paniculite criptocócica em transplantado renal

“…O acometimento cutâneo ocorre por disseminação hematogênica, tendo sido descritos poucos casos por inoculação direta. 3,6 Nas formas disseminadas, as lesões cutâneas podem ocorrer em 10 -15% dos casos, de modo polimórfico, como pápulas, pús-tulas, abcessos ou ulcerações, sendo rara a ocorrência de paniculite. [3][4][5]7 Para alguns autores, o acometimento cutâneo é sinal de mal prognóstico.…”

“…Assim, os portadores da síndrome da imunodeficiência adquirida (Aids) e os transplantados de órgãos sólidos podem ser considerados integrantes da população de risco. [1][2][3] O sítio mais acometido é o pulmonar, já que a via inalatória é a principal porta de entrada da infecção, podendo haver posterior disseminação para outros órgãos. Nos pacientes de criptococose disseminada, o acometimento da pele pode ocorrer em 10-15% dos casos, 2,4 com apresentação variável incluindo paniculite.…”

“…5,4 Nos transplantados renais, a criptococose ocorre em 0,8 -5% dos pacientes, na dependência do tipo e da intensidade da imunossupressão. 3 A infecção é geralmente observada no pós-operatório tardio, cerca de quatro meses após a introdução das drogas imunossupressoras.…”

Myositis due toCryptococcus neoformansin a Diabetic Patient

“…Skin and soft tissue involvement of cryptococcal infection is rare [7] and only a handful of cases of cryptococcal myositis have been reported [2,8,9]. A case of cryptococcal infection that involve the skeletal muscle has been described in a patient with diabetes mellitus, but he also had another risk factor for cryptococcosis [10,11]. In domestic case, one case was reported about cryptococcal tenosynovitis with multiple lung nodules in the patient with Wegener's granulomatosis [12].…”

Tzanck Smear as a Rapid Diagnostic Tool for Disseminated Cryptococcal Infection

“…In immunocompromised hosts, cutaneous cryptococcosis almost always represents disseminated disease. 2,3 Cutaneous involvement may antedate other signs and symptoms of disseminated cryptococcal disease, such as meningitis, and can be an early clue to diagnosis. 2 If untreated, dissemi-nated cryptococcosis has a high mortality rate; however, with diagnosis and therapy, the 70% to 80% 2-year mortality rate of disseminated cryptococcosis can be reduced to 10% to 15%.…”