Cutaneous cryptococcosis in two patients with acquired immunodeficiency syndrome

Abstract

We present 2 cases of systemic cryptococcosis with cutaneous involvement in patients with acquired immunodeficiency syndrome (AIDS). Both patients were male, intravenous drug abusers, 31 and 35 years old, with severe immunodepression and a CD4+ lymphocyte count of 10/ml and 1/ml, respectively. They both had papular lesions reminiscent of molluscum contagiosum and in one patient with concomitant systemic leishmaniasis, there were spores of Cryptococcus neoformans coexisting with the leishmanias in the cutaneous lesions, constituting the first reported case of this particular association. Both patients responded well to amphotericin B followed by fluconazole.

Rare presentation of cutaneous cryptococcosis in advanced HIV

“…Incidence has decreased, but remains a major burden to global health, with approximately 1 million cases occurring annually worldwide 5. Primary infection normally occurs in the lungs following inhalation, and then disseminates haematogenously 6. It is a neurotropic organism, causing meningoencephalitis, associated with a high mortality.…”

“…Lesions vary in appearance, commonly presenting as papulonodular molluscum-like lesions with an umbilicated centre and most often over face 3 8. Acneiform, nodular, herpetiform, ulcerated and lesions mimicking cellulitis are also recorded 6. Prior to the HIV epidemic, there were isolated case reports of cryptococcosis among immunosuppressed people presenting as gummatous lesions, subcutaneous abscesses or tumour-like swellings with or without sinus formation 9.…”

Co‐infection of molluscum contagiosum virus and cryptococcosis in the same skin lesion in a HIV‐infected patient

“…has the propensity to cohabitat pre‐existing dermatoses. Various conditions described with this phenomenon are Kaposi’s sarcoma 8,9 and different infective lesions like cutaneous leishmaniasis 10 and co‐infection with Pneumocystis carinii 11 and fusospirochetal organisms 12 . Also (s), co‐infection of MC with Cryptococcus sp.…”

A Case of Systemic Cryptococcal Disease in HIV Infection

“…Sabouraud agar and blood agar within 24-48 hours (7). It is a saprophytic organism and can be found worldwide.…”