Cutaneous Cryptococcosis

Abstract

Cutaneous cryptococcosis is classified either as primary or secondary based on the route of infection. The disease can also be classified either as localized cutaneous cryptococcosis or cutaneous manifestations of disseminated cryptococcosis. However, from a physician's point of view, whether lesions are localized to the skin or are disseminated/systemic is more important than the route of infection. The Clinical Practice Guidelines for Diagnosis and Treatment of Cryptococcosis, which was established in 2019 by the Japanese Society for Medical Mycology, adopted the latter classification. Localized cutaneous cryptococcosis is defined as a condition in which lesions are confined within a limited part of the skin, not systemically disseminated at the same time, and are associated with neither cryptococcal fungemia nor antigenemia. This type of cutaneous cryptococcosis is uncommon in Japan. Only 65 cases were reported during the 50-year study period from 1968 to August 2018, with the patients divided into two groups: immunocompromised patients (n = 44, 68%) and immunocompetent patients (n = 21, 32%). None of the patients were infected with the human immunodeficiency virus (HIV). Localized cutaneous cryptococcosis can also occur in non-HIV-infected patients and well-appearing individuals, therefore, it is considered an important infection in routine dermatology practice. Here, we outline the classification, diagnosis, and treatment of cutaneous cryptococcosis and present a summary of cutaneous cryptococcosis cases reported in Japan.

Disseminated cutaneous cryptococcosis in an immunocompetent elderly long‐term pigeon fancier

“…It was proposed that cases with multifocal skin lesions, and histological findings of inflammation centered in the deep dermis, should be classified as secondary disease . Furthermore, clinical practice guidelines for diagnosis and treatment of cryptococcosis published in 2019 by the Japanese Society for Medical Mycology indicated that treatment should be selected according to presence of cryptococcal meningitis when the lesion is discontinuous and occurs in multiple areas . Accordingly, the present case was diagnosed as disseminated cryptococcosis with multiple skin lesions.…”

A case of disseminated cryptococcal disease after Bruton tyrosine kinase inhibitor therapy: A brief review in the Australian context

“…Reported features include nodules, pustules, acneiform papules, molluscum contagiosum-like lesions, ulcerations, cellulitides, and plaques. 6 In immunosuppressed patients, disseminated disease is frequently reported as umbilicated papules, nodules and violaceous plaques. Most reported cases of C. neoformans skin findings occur in the setting of disseminated cryptococcosis, which is reported in only around 10%-15% of the presentations.…”

“…Relevant investigations to distinguish primary disease from disseminated cryptococcal infection include blood culture, cerebrospinal fluid culture and cryptococcal antigen titers, urine microscopy and culture, glucuronoxylomannan antigen testing, chest computed tomography scan, and occasionally bronchoscopy. 6 …”

Primary Cutaneous Cryptococcosis: An Unusual Injection Site Infection

“…The organism initially affects the respiratory tract, and from there dissemination can occur to other organs such as the skin (in up to 15% of cases [1]), the central nervous system, and other organs [2]. Although cryptococcosis commonly affects HIV-infected patients, other patients with chronic immunosuppression might be infected as well [3,4]. Two species are frequently isolated: Cryptococcus neoformans and Cryptococcus gattii.…”