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.

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.

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.

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.

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.