Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D

Abstract

We report a healthy, 73-year-old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X-rays were normal. Histopathological findings showed granulomatous cell infiltration. Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neoformans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.

Primary Cutaneous Cryptococcosis in an Immunocompetent Host: Case Report and Review of the Literature

“…PCC in the immunocompetent host has only been described in case reports [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]. Noble and Fajardo [27]established three criteria to consider a case as PCC: (1) absence of infection in any other viscera; (2) C. neoformans must be isolated from the skin; (3) absence of extracutaneous infection within 4 weeks after the PCC diagnosis.…”

“…Two of these 5 patients [16, 17]were infected by the serotype D of C. neoformans var. neoformans which, according to some authors [16], has some more tropism for the skin. One patient was infected by C. neoformans var.…”

“…In 1 case, the patient was a pigeon keeper himself [17], and 2 other patients presented either with cutaneous ulcers after skin abrasions [16]or with extensive leg cellulitis [19]without a previous trauma. Both patients could have suffered a bacterial skin infection which was later colonized by C. neoformans var.…”

“…gattii an opportunistic microorganism as it commonly infects nonimmunosuppressed hosts [3, 21]. Naka et al [16]consider that serotype D has some more tropism for the skin.…”

“…neoformans in his third right finger after an accidental puncture caused by a metallic object at his workplace. We have found another 16 cases of PCC in immunocompetent individuals in our literature review (Medline database) of the last 38 years [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]. …”