Disseminated Cryptococcosis Presented as Necrotizing Fasciitis of a Limb

Huang, Kuo Chin; Tu, Yuan Kun; Lee, Kam Fai; Huang, Tiao‐Lai; Hsu, Robert Wen-Wei

doi:10.1097/01.ta.0000246581.83536.68

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Soft-tissue fasciitis in cryptococcosis may follow haematogenous dissemination of the organism or trauma (Jain et al , 2006). Rarely, cryptococcal fasciitis has been reported at injection sites within an extremity (Huang et al , 2007). …”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole‐resistant Cryptococcus neoformans

et al. 2014

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Introduction:Cryptococcus neoformans is an encapsulated budding yeast that is a common cause of opportunistic infections, rarely giving rise to cellulitis, vasculitis or fasciitis. Necrotizing fasciitis caused by C. neoformans is a rare but serious problem in post-transplant immunosuppression.Case presentation:We report a case of cryptococcal necrotizing fasciitis in the left adductor longus of a patient on immunosuppressive therapy. The patient’s medical history was significant for orthotopic heart transplant secondary to cardiac and systemic amyloidosis (AL type) with subsequent cardiac biopsy demonstrating mild rejection (grade 1R). A thigh muscle biopsy demonstrated numerous encapsulated fungi in the fascia and no evidence of myositis. Cryptococcal antigen was subsequently identified in the patient’s serum and cerebrospinal fluid. The patient progressed to involvement of the central nervous system, left biceps femoris and skin of the left lower leg by fluconazole-resistant C. neoformans.Conclusion:This case illustrates a rare initial presentation of disseminated fluconazole-resistant C. neoformans as an isolated necrotizing fasciitis of the thigh. Necrotizing fungal fasciitis should be considered in immunosuppressed patients with clinical findings of either myositis or cellulitis of a lower extremity.

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Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole‐resistant Cryptococcus neoformans

et al. 2014

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“…In a review of the literature, we identified 7 reported cases of necrotizing vasculitis or necrotizing fasciitis attributed to C. neoformans infection (9–16) (Table 1). Four cases occurred in organ transplant recipients, while 3 cases occurred in patients with other significant underlying disorders.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal disease presenting as necrotizing cellulitis in transplant recipients

Baer

Baddley

Gnann

et al. 2009

Transplant Infectious Dis

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Disseminated cryptococcosis uncommonly presents with skin lesions in immunocompromised hosts. Necrotizing fasciitis, necrotizing vasculitis, myositis, or necrotizing soft tissue infection are even more rare presentations. We report 3 cases of cryptococcal necrotizing soft tissue infection, 2 in renal transplant patients, and 1 in a heart transplant patient, and discuss similar cases from the literature. Cryptococcus neoformans should be considered in the differential diagnosis of cellulitis or necrotizing soft tissue infections in immunocompromised patients.

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A case of disseminated cryptococcosis with necrotizing fasciitis in a non‐HIV patient

Hoshino¹,

Omura²,

Kimura³

et al. 2017

Acute Medicine & Surgery

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CaseDisseminated cryptococcosis is a well‐recognized condition among HIV patients, but it also occurs in non‐HIV patients. Necrotizing fasciitis caused by cryptococcus is rare. An 81‐year‐old man who had received steroid therapy presented with erythema and pain in his right thigh. After the rapid progression of symptoms and a failure to respond to antibiotic therapy, a clinical diagnosis of necrotizing fasciitis was made. We performed debridement, and yeasts were detected using a Gram stain of the fascia. We treated the patient with liposomal amphotericin B. On day 3, he developed meningitis. Cryptococcus neoformans was detected in the blood, fascia, and cerebrospinal fluid. Flucytosine was added to liposomal amphotericin B.OutcomeDespite the antifungal treatment, new regions of dissemination to the skin developed, and the patient died of multiple organ failure.ConclusionA diagnosis of disseminated cryptococcosis should be considered in a differential diagnosis of necrotizing fasciitis among immunocompromised patients, regardless of their HIV status.

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Disseminated Cryptococcosis Presented as Necrotizing Fasciitis of a Limb

Cited by 7 publications

References 12 publications

Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole‐resistant Cryptococcus neoformans

Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole‐resistant Cryptococcus neoformans

Cryptococcal disease presenting as necrotizing cellulitis in transplant recipients

A case of disseminated cryptococcosis with necrotizing fasciitis in a non‐HIV patient

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