Primary cutaneous cryptococcal cellulitis secondary to insect bite in an immunosupressed patient after liver transplantation

Abstract

Cutaneous cryptococcosis is usually a manifestation of disseminated disease, especially in immunosuppressed patients. Primary cutaneous cryptococcosis has also been described in some patients without evidence of systemic disease. Distinguishing between primary and secondary cutaneous cryptococcosis may be difficult as patients can be asymptomatic or cutaneous lesions may precede systemic involvement by some months. Features supporting primary disease are a history of cutaneous inoculation, and solitary superficial lesions on uncovered parts of the body. We present a liver transplant patient with cutaneous cryptococcal cellulitis subsequent to an insect bite, without systemic involvement and with excellent response to treatment with amphotericin B for 15 days and surgical debridement plus oral fluconazole for 3 months. In immunosupressed patients with cellulitis a cryptococcal infection must be excluded. If cutaneous cryptococcosis is diagnosed, systemic evaluation and prompt lengthy treatment are required.

The solitary lymphomatous papule, nodule, or tumor

“…Differential diagnoses of a solitary papule, nodule, or tumor suggestive of lymphoma are listed in Table II [16][17][18][19][20][21][22][23][24][25][26][27] Although there are a number of case series of lymphomas that include a mix of patients presenting with solitary and multiple lesions, they 16 Hwong et al, 18 Arai et al, 21 Jones et al, 22 Billings et al, 23 Evans et al, 24 Oliver and Winkelmann, 25 Mitchell, 26 and Wood et al 27 previously reported a total of 41 patients who presented with solitary papule, nodule, or tumor. Their diagnoses ranged from CLH, 18,24 pseudolymphomatous folliculitis, 21 and lymphomatoid papulosis 24 to Langerhans cell histiocytosis, 23 MF, [25][26][27] primary cutaneous ALCL, 16 and other lymphomas.…”

Primary Cryptococcal Cellulitis in a Lung Transplant Recipient

“…A review of all 23 published patient reports is listed in Table 1. 2,5,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The present case report is the third on cryptococcal cellulitis after lung transplantation. At presentation, cryptococcal cellulitis is often mistaken for bacterial cellulitis.…”

Primary Cutaneous Cryptococcosis Treated with Debridement and Fluconazole Monotherapy in an Immunosuppressed Patient: A Case Report and Review of the Literature

“…Primary cutaneous cryptococcosis (PCC) is defined as identification of Cryptococcus neoformans in a skin lesion without evidence of simultaneous disseminated disease [ 35 ]. Most cases of PCC have been reported from Europe, Japan, and South America [ 6 , 7 , 9 – 12 , 16 – 21 , 30 , 31 , 35 ]. A nationwide survey conducted by the French Cryptococcosis Study Group identified 28 cases of PCC of the 1,974 total cryptococcosis cases reported to the National Reference Center for Mycoses from 1985 to 2000.…”