Cutaneous Cryptococcus infection and AIDS. Report of 12 cases and review of the literature

Murakawa, G. J.

doi:10.1001/archderm.132.5.545

Cited by 24 publications

(22 citation statements)

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“…Cutaneous manifestations of primary cryptococcal infection is varied (Table 3) and descriptions in the literature range from acneiform lesions to vesicular lesions mimicking Herpes simplex or H. zoster, nodular, nodulo-ulcerative to frank ulceration, simulating pyoderma gangrenosum [51], molluscum contagiosum in non-HIV infected patients [52], and Kaposi's sarcoma [53], basal cell carcinoma [54] and molluscum contagiosum [55] in HIV patients. It should be noted that cellulitis often has a similar presentation to bacterial cellulitis.…”

Section: Cutaneous Manifestationsmentioning

confidence: 99%

Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts

Christianson¹,

Engber²,

Andes³

2003

Med Mycol

104

100

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A case of primary cutaneous cryptococcal infection is presented and cases of primary cutaneous cryptococcosis in normal and immunocompromised hosts are reviewed. Cutaneous cryptococcosis can occur from local inoculation or dissemination from a distant site of infection. Risk factors associated with development of primary cutaneous cryptococcosis are those which affect cell-mediated immunity, such as corticosteroid usage, solid organ transplantation, sarcoidosis and immunosuppression. The cutaneous manifestations of cryptococcosis are protean and may mimic other cutaneous diseases. Patients with a diagnosis of cryptococcosis from a skin biopsy or culture should undergo evaluation to exclude disseminated disease and an evaluation of cell-mediated immunity. Although some patients do well without antifungal therapy, these patients cannot be discerned prospectively and therefore antifungal therapy appears warranted in all patients with localized disease. Choice of therapy depends on the extent of disease and immunocompetence of the host.

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Section: Cutaneous Manifestationsmentioning

confidence: 99%

Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts

Christianson¹,

Engber²,

Andes³

2003

Med Mycol

104

100

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“…Cutaneous cryptococcosis is an opportunistic infection, and occasionally involves immunocompromised hosts, such as patients with HIV infection, hepatitis C virus infection, lymphomas, systemic lupus erythematosus, and transplant recipients receiving immunosuppressive therapies (3)(4)(5)(6)(7). Case 1, who had been suffering from erythroderma, and was immunosuppressed with systemic prednisolone therapy.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Cryptococcosis Mimicking Pyoderma Gangrenosum: A Report of Four Cases

Kikuchi¹,

Hiraiwa²,

Ishikawa³

et al. 2016

Acta Derm Venerol

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SHORT COMMUNICATIONCryptococcosis is a fungal infection caused by Cryptococcus neoformans, and frequently presents with meningitis, pneumonia, and cutaneous eruptions in immunocompromised patients. Clinical features of cutaneous cryptococcosis vary; thus, it is necessary to suspect the disease and perform a skin biopsy in order to make an early and accurate diagnosis. We herein report 4 cases of cutaneous cryptococcosis presenting with pyoderma gangrenosum-like appearance. CASE REPORTCase 1. An 85-year-old woman was admitted to hospital, complaining of fever, as well as ulcers on the face, neck, and upper extremities. She had been suffering from erythroderma and was treated with prednisolone (20 mg/day) for the previous year. Physical examination revealed deep irregular ulcers with necrosis on the upper extremities ( Fig. 1a) and nodular lesions with crusts on the neck. In addition, erythema and hemorrhagic blisters were found on the left lower leg. Laboratory examination showed leukocytosis (10,400/μl), elevated C-reactive protein (CRP) (4.21 mg/dl) and β-D-glucan (56.1 pg/dl: normal 0-11) levels, and positive C. neoformans antigen. Histological examination revealed granulomatous inflammation infiltrated with lymphocytes and histiocytes, and degeneration of the dermis and subcutaneous fat tissues. Numerous rounded fungal bodies positively stained by PAS and Grocott were found in the subcutaneous fat tissue. Microbiological culture from ulcer exudate showed C. neoformans. Examination by computed tomography (CT) revealed pneumonia, and a cerebral abscess was detected by magnetic resonance imaging (MRI). The ulcers healed after intravenous administration of fluconazole (200 mg/ day), however the patient died of sepsis.Case 2. A 74-year-old woman presented with an ulcer on the right lower leg that had appeared 6 months previously. She had been treated at an internal medicine clinic, but the ulcer deteriorated. She was also suffering from diabetes mellitus, chronic kidney disease and bronchial asthma. Physical examination revealed irregular ulcers with necrosis on the right lower leg (Fig. 1b). Laboratory examination showed a normal white blood cell count (7,500/μl), elevated CRP (0.97 mg/dl) and β-D-glucan (12.4 pg/dl) levels, and positive C. neoformans antigen. Histological examination revealed inflammatory infiltrates of lymphocytes and histiocytes in the dermis, and a number of fungal bodies stained with PAS, Grocott, and mucicarmine were found in the dermis (Fig. 2). Culture from ulcer exudates as well as blood verified C. neoformans. Chest CT revealed pneumonia, and two weeks after administration, she died of respiratory failure. Case 3. A 93-year-old woman was hospitalized, complaining of redness and swelling of the thighs for the previous month. She had been treated without response with antimicrobial drugs. Physical examination revealed irregular deep ulcers with necrosis on the right thigh (Fig. 1c). Laboratory examination showed leukocytosis (11,680/μl), elevated CRP (4.24 mg/dl) level, normal β-D-glucan (...

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“…2 Even in the patients with AIDS, the cutaneous lesions usually present as non-NF soft tissue infection, not fatal NF. 3,4 Although such infection types are frequent in compromised patients, it is important to understand they can occur in normal hosts as well. Disseminated cryptococcosis with fatal NF is very rare, especially in a nonimmunocompromised patient.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] In patients with a disseminated form of the disease, the organism is presumed to be inhaled, infecting the lungs first and then spreading hematogenously to other organs, most frequently to the meninges. Disseminated cryptococcosis with the early appearance of a fatal necrotizing fasciitis (NF) is very rare and, to the authors' knowledge, unreported in the literatures.…”

mentioning

confidence: 99%