Pancytopenia and cutaneous cryptococcosis as an indicator disease of acquired immune deficiency syndrome.

We present a case of pancytopenia and cutaneous cryptococcosis in a young girl with no complaints of fever, headache and vomiting. Fine‑needle aspiration cytology and further investigation for pancytopenia revealed presence of Cryptococcus in skin and bone marrow aspirates. Fungal cultures of the skin aspirates, blood and bone marrow confirmed cryptococcal infection. Counselling and human immunodeficiency virus (HIV) test revealed the status of the patient to be retropositive. Although meningitis is the commonest manifestation of cryptococcosis among HIV‑infected patients, rare cutaneous manifestation with pancytopenia but with no meningeal signs indicate the HIV status in an endemic area of penicilliosis, Manipur.

A Case of Primary Cutaneous Cryptococcosis Arising on the Abdomen and Review of the Literature / 대한의진균학회지

Primary cutaneous cryptococcosis is isolated cutaneous cryptococcosis without evidence of systemic involvement. It usually presents as a solitary nodule in an exposed area, such as head and neck or extremities, and the occurrence of primary cutaneous cryptococcosis in the covered area has been rarely reported in the literature. A healthy 81-year-old immunocompetent woman presented with a solitary reddish scaly plaque on her abdomen without clinical evidence of systemic cryptococcal infection. Histopathologic examination showed numerous encapsulated spores, and the organism was identified as Cryptococcus neoformans in a series of fungal studies. We diagnosed this case as a primary cutaneous cryptococcosis by the findings mentioned above. The patient was successfully treated with surgical excision and oral fluconazole without any side effects.

Primary Cutaneous Cryptococcosis in a Patient with Pulmonary Tuberculosis / 대한의진균학회지

Cutaneous manifestation due to Cryptococcus neoformans is mostly reported in cases of the secondary findings to hematogenous dissemination while the primary cutaneous cryptococcosis (PCC) is a very rare. PCC usually occurs in immunocompromised hosts such as AIDS, hematopoietic malignancies, transplant recipients, and chronic corticosteroid users. Primary cryptococcosis and tuberculosis co-infection has been rarely reported in Korean literature. We report a case of PCC in a 22-year-old male with pulmonary tuberculosis, who had asymptomatic erythematous plaque and papules on the right cheek for 3 months. Histopathological examination showed numerous encapsulated round spores in the dermis and the organism was identified as Cryptococcus neoformans on fungal culture. The lesion was successfully treated with oral fluconazole for 6 months, and pulmonary tuberculosis was resolved after anti-tuberculosis therapy for 9 months.

Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing's Syndrome: A Case Report and Review of the Literature / 대한임상미생물학회지

Cryptococcus neoformans (C. neoformans) is a ubiquitous yeast-like fungus that has been a common opportunistic human pathogen, especially in immunocompromised patients. Although skin lesions due to C. neoformans are found in 10-15% of patients with systemic cryptococcosis, primary cutaneous cryptococcosis without systemic infection is rare and now considered a distinct clinical entity. We report a case of primary cutaneous cryptococcosis in a patient with iatrogenic Cushing's syndrome. A 73-year-old woman presented with pain and discharge from lesions on her left forearm. The patient had been treated with oral corticosteroids for 20 years, and as a result had developed iatrogenic Cushing's syndrome. A skin fragment of the ulcer was cultured, and the encapsulated fungus were isolated and identified as C. neoformans using a Vitek2 system (Vitek2 ID-YST, bio Merieux, France) and API 20C (bioMerieux). Concurrent blood and urine cultures were negative for growth. At first, she was treated with antibiotics due to suspicion of cellulitis. After surgical resection and treatment with systemic and oral fluconazole, her wound was improved with scar. Primary cutaneous cryptococcosis should be considered when skin lesions are not responsive to antibiotics and accurate identification is important for proper treatment.

Cutaneous cryptococcosis due to Cryptococcus gattii in a patient on chronic corticotherapy / Criptococose cutânea causada por Cryptococcus gattii em um paciente sob corticoterapia crônica

Cryptococcus gattii é agente causador de uma micose endêmica que afeta principalmente os pulmões e o sistema nervoso central de pacientes imunocompetentes em regiões tropicais e subtropicais do globo. Relato de caso. Um paciente de 66 anos, portador de doença pulmonar obstrutiva crônica, não infectado pelo vírus HIV, em corticoterapia sistêmica prolongada, desenvolveu extensa ulceração do antebraço esquerdo, associada a adenomegalia supraclavicular ipsilateral, em conseqüência à infecção por Cryptococcus gattii. O paciente foi tratado com fluconazol 400mg/dia durante 8 meses, obtendo resolução completa da lesão. Este caso enfatiza que, ainda que raramente, C. gattii pode causar infecção cutâneo-linfática oportunista, em paciente imunocomprometido pelo uso sistêmico de corticosteróides vivendo na região sudeste do Brasil.

Cryptococcus gattii causes a form of endemic mycosis that most commonly affects the lungs and central nervous system of immunocompetent patients living in tropical and subtropical areas of the world. Case report. A 66-year-old man who had chronic obstructive pulmonary disease without HIV infection and had been on systemic corticotherapy for several years developed extensive ulceration of the left forearm that was associated with ipsilateral supraclavicular adenomegaly, consequent to infection with Cryptococcus gattii. The patient was treated with fluconazole 400mg/day for eight months, which led to complete healing of the lesion. This case emphasizes that, although rare, C. gattii may cause opportunistic cutaneous-lymphatic infection in patients living in the southeastern region of Brazil who are immunocompromised through chronic corticotherapy.

Diagnóstico de criptococosis a partir de lesiones cutáneas / Diagnosis of cryptococcosis in cutaneous lesions

Se realizó el diagnóstico de criptococosis en un paciente con lesiones cutáneas de aspecto moluscoide, presentes en gran número en el rostro, sospechadas clínicamente de ser provocadas por Histoplasma capsulatum. El paciente, posteriormente diagnosticado como VIH positivo, presentó además Cryptococcus neoformans en el LCR y fue tratado con anfotericina B endovenosa. Con material obtenido por escarificación de las lesiones se realizaron extendidos y practicaron cultivos. Aplicadas a los extendidos, las coloraciones de Giemsa, Grocott y mucicarmín de Mayer, permitieron la observación de levaduras redondas y capsuladas que en los cultivos en agar semillas de girasol desarrollaron colonias de color pardo que correspondieron a Cryptococcus neoformans.

Diagnosis of cryptococcosis was performed in a patient with multiple cutaneous Muluscum contagiosumlike lesions in the face, clinically suspected as produced by Histoplasma capsulatum. The patient, after being diagnosed HIV positive, also showed Cryptococcus neoformans in the CSF, and was treated with intravenous amphotericin B. Clinical samples from the skin lesions were obtained and smears stained by Giemsa, Grocott and Mayer's mucicarmin were performed. Part of these samples, obtained by scrapping the ulcers, were suspended in isotonic saline solution and cultivated in Sabouraud dextrose agar and sunfloweragar; Cryptococcus neoformans colonies were identified.

A Case of Primary Cutaneous Cryptococcosis Misdiagnosel as Skin Tuberculosis / 대한의진균학회지

Cryptococcosis is an opportunistic yeast infection caused by Cryptococcosis neoformans. The cutaneous manifestations are usually polymorphic and nonspecific. Lesions may appear as subcutaneous swelling, abscesses, tumor-like masses, papules or large ulcers. Therefore, diagnosis of cutaneous cryptococcosis is quite difficult and often delayed. Clinical suspicion is very important in diagnosis. A 47-year-old man presented with a ulcerative nodule on the right side of the neck. Because initial skin biopsy revealed granulomatous lesion, we misdiagnosed his lesion as skin tuberculosis and treated him with anti tuberculosis medication for 6 months. But his symptom was not improved. After second biopsy specimen had showed some spores with narrow neck budding, we confirmed this case as a cryptococcosis and successfully treated with itraconazole (200 mg/day) for 12 weeks.

A Case of Cutaneous Cryptococcosis Clinically Mimicking Keratoachantoma / 대한의진균학회지

Cutaneous involvement of patient with systemic cryptococcosis occur in 10% to 15% of the case reported in literature. We report a case of cutaneous cryptococcosis clinically mimiking keratoacanthoma in a 70-year-old male. The lesions showed multiple erythematous papules and elevated central crusted nodules with peripheral telangiectasia on the face, and he had been treated with chemotherapy for peripheral T-cell lymphoma. The skin biopsy specimen showed granulomatous reaction with lympohistiocytic infiltration and many round spores. The fungus culture from skin lesion showed mucoid creamy colored colonies and revealed microscopically thick encapsulated spores in India ink preparation. The culture on Christensen urea agar at 25degrees C for 1 week was positive. The patient was treated with intravenous administration of fluconazole 200 mg/day for a week with partial improvement. But he refused further treatment, and died after a month of discharge.

Primary Cutaneous Cryptococcosis Treated with Fluconazole / 대한피부과학회지

We report a case of primary cutaneous cryptococcosis in a 63-year-old female, who had a painful deep ulceration on the left forearm for 2 months. Histopathological examination showed numerous encapsulated round spores in the dermis and subcutis. A tissue culture on Sabouraud's media without cycloheximide showed whitish creamy colonies and revealed budding yeast cells in lactophenol cotton blue preparations. The organism was identified as Cryptococcus neoformans. The lesion was successfully treated with oral fluconazole(400 mg/day) for 2 months combined with surgical debridement.

Cutaneous Cryptococcosis Clinically Mimicking Necrotizing Fasciitis

Secondary cutaneous cryptococcosis may occur earlier than other manifestations of disseminated cryptococcosis. A 68-year-old woman presented with multiple ulcerative lesions on the right calf of 2 weeks duration. She had been treated with antibiotics, but the lesions spread rapidly. The initial clinical impression was necrotizing fasciitis, but routine KOH mounting from the ulcerative lesions showed numerous budding yeast cells with peripheral clear zones and further investigations including a skin biopsy, tissue cultures and India ink preparations allowed a rapid and definitive diagnosis of cutaneous cryptococcosis. Studies for other evidence of infection elsewhere revealed an asymptomatic pulmonary lesion. We report a case of secondary cutaneous cryptococcosis clinically mimicking necrotizing fasciitis that occured before other manifestations of disseminated cryptococcosis.

Two Cases of Cutaneous Cryptoccosis Mimicking Cellulitis / 대한의진균학회지

Crytococcus neofomans is an encapsulated budding yeast with well-defined ecological biotopes and the second most common nose of the fungal infection in immunocompromised patients. It is 18re for a cryptoccosis infection to be localized only to the skin. We report two cases of cryptococcosis mimicking cellulitis. The frist case was suspected as primary cutaneous cyptococcosis in the 57-year-old female SIE patient who had been treated with prednisolone 60 mg/day for 1 month. Erythematous swollen patch developed on the left thigh and subsided spontaneously without relation to the course of 519 after 2 weeks of onset. The second case developed in the 45-year-old female patient with adrenal cancer. Erythematous patches developed on the medial sides of both thighs. The lesions were resistant to the combination therapy of amphotericin B 0-7 mg/kg/day and 5-fluorocytosine 100 mg/kg/day and the patient died after 1 month of treatment.

A Case of Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing's Syndrome / 대한의진균학회지

We presented here a case of the primary cutaneous cryptococcosis in a patient with iatrogenic Cushing's syndrome. The patient was 72-year-old female and showed painful shallow ulcer with pus discharge on the left forearm. She had been receiving systemic corticosteroids without doctor's prescription for 20 years. Laboratory findings revealed impaired cell mediated immunity, decreased serum and urine cortisol, and ACTH. A biopsy specimen showed granulomatous reaction consisting of lymphohistiocytes, multinucleated giant cell, and many spores with thick capsules. A tissue and pus culture of the lesion on Sabouraud's media at 37 degrees C showed moist smooth, mucoid creamy colored colonies 3 days later and revealed encapsulated yeast cells in the India ink preparations. The patient was successfully treated with oral itaconazole and fluconazole without side effects.

Primary Cutaneous Cryptococcosis Treated with Itraconazole / 대한의진균학회지

In most instances, Cryptococcosis is a systemic disease caused by the yeast-like fungus Cryptococcus neoformans through respiratory tract. The organism is worldwide in its distribution, is saprophytic, and is found in soil and in pigeon excretion. Primary cutaneous cryptococcosis is rare; skin lesion is the sole manifestation of the disease without preceding generalized or cerebrospinal involvement. We report a case of primary cutaneous crytococcosis. The patient was a 53-year-old female, who had had an erythematous ulcerated lesion with swollen border on the dorsum of right wrist. Histopathologic examination showed typical spores with capsules. Other physical examinations and laboratory findings were within normal limit. The lesion was successfully treated with oral itraconazole (200mg/dayx7weeks).

Two Cases of Primary Cutaneous Cryptococcosis / 대한피부과학회지

We report two cases of primary cutaneous cryptococcosis that is a very rare disease. One patient was a 45 year-old female, who had had an erythematous hard nodule on dorsum of right wrist for ten months, The other patient was a 53-year-old male, who had had itching and burning erythematous rashes on left auricle for ten months. Histopathologic examination showed typical spores with capsules, Other physical examination and laboratory findings were within nomal limit. Our patients were successfully treated with excision and combination of amphotericin B and 5-fluoro-cytosine.

A Case of Primary Cutaneous Cryptococcosis Successfully Treated with Topical Application of 5-Fluorocytosine Ointment / 대한피부과학회지

Primary cutaneous cryptococcosis of ulcers and plaques developed on the face of an otherwise healthy 7-year-old boy. Lesions were successfully treated with 10% 5-fluorocytosine ointment under occlusive dressing, Cultures for the organism from the involved area became negative after 10 weeks of treatment but the organism was observed under microscope until 10 weeks after treatment. The extensively ulcerated granulomatous lesions healed with scar formation in 15 weeks. The patient had completed 20 weeks of treatment. Follow-up examination for 1 year showed no evidence of recurrence.