Cutaneous Cryptococcosis Clinically Mimicking Necrotizing Fasciitis

ABSTRACT

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.