Localized Cutaneous Cryptococcosis in a Patient with Chronic Myeloproliferative Disease

Abstract

We report a 60-year-old Japanese woman who came to our clinic in October of 2003. Ten days before presentation, a reddish, firm, painless nodule had appeared on her left thigh. She had been treated with oral prednisolone 10 mg per day for 9 months, and oral hydroxycarbamide for two years, for chronic myeloproliferative disease, a pre-leukemic state similar to chronic myeloid leukemia. In 2002, she developed hepatic cancer from liver cirrhosis caused by hepatitis B and/or C viruses.Physical examination at presentation: Her temperature, pulse and blood pressure were normal. Laboratory studies showed blast cells in the blood profile, and elevations of AST, ALT, and AFP, which were associated with the myeloproliferating disease and hepatic cancer. Serology for human immunodeficiency virus (HIV) was negative. The CD4 count was 239/m 3 , and the CD8 count was 329/m 3 . Chest X-ray showed no nodules. Cerebrospinal fluid (CSF) was not examined. A reddish, firm nodule measuring approximately 15 mm in diameter was found on her left inner thigh (Fig. 1). No local lymphadenopathy was present.

Cryptococcus neoformans infection in malignancy

“…In the reviewed cases, 86 patients (15%) were reported to have solid tumours, although four patients also had a concurrent haematologic malignancy (chronic lymphocytic leukaemia & prostate cancer, adult T‐cell leukaemia/lymphoma & gastric cancer, myeloproliferative disorder & liver cancer, cutaneous T‐cell lymphoma & breast cancer). These four patients were counted as haematologic malignancy rather than solid tumour for analysis.…”

“…The PubMed search resulted in 545 manuscripts, 137 of which contained unique and relevant patient data and fulfilled the inclusion and exclusion criteria . These publications included a total of 581 cases of cryptococcal disease in cancer patients.…”

Localized Cutaneous Cryptococcosis: Summary of Reported Cases in Japan

“…Cutaneous cryptococcosis localized to the skin with neither visceral lesions nor a history of trauma was first referred to as localized cutaneous cryptococcosis by Geyer et al in 1984 4) . In Japan, since the report by Tanabe et al in 1987 5) , localized cutaneous cryptococcosis has been distinguished from primary or secondary cutaneous cryptococcosis (Table 1) , and 36 cases have been reported to date 6,7) . Herein, we report our recent experience with a typical case of localized cutaneous cryptococcosis.…”