ABSTRACT
Primary cutaneous infection with Cryptococcus neoformans is uncommon, but can occur following an inoculation injury to the skin. Tumor necrosis factor-alpha (TNF-alpha) is important in the immune response to Cryptococcus, and patients taking inhibitors of TNF-alpha may have increased susceptibility to cryptococcal infection. We report a case of primary cutaneous cryptococcosis in a patient taking adalimumab, methotrexate, and hydroxychloroquine for rheumatoid arthritis.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Cryptococcosis/diagnosis , Dermatomycoses/diagnosis , Methotrexate/therapeutic use , Adalimumab , Antibodies, Monoclonal, Humanized , Antifungal Agents/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Cryptococcosis/complications , Cryptococcosis/drug therapy , Cryptococcus neoformans/drug effects , Cryptococcus neoformans/growth & development , Cryptococcus neoformans/isolation & purification , Dermatomycoses/complications , Dermatomycoses/drug therapy , Female , Finger Injuries/complications , Finger Injuries/diagnosis , Finger Injuries/microbiology , Fluconazole/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Middle AgedABSTRACT
BACKGROUND: Calciphylaxis is characterized by ischemic cutaneous ulceration, high mortality, and ineffective treatment. METHODS: We conducted a retrospective study of 64 patients with calciphylaxis (including 49 dialysis patients age- and sex-matched to 98 dialysis controls). RESULTS: The estimated 1-year survival rate of calciphylaxis was 45.8%. Risk factors for calciphylaxis included obesity, liver disease, systemic corticosteroid use, calcium-phosphate product more than 70 mg(2)/dL(2), and serum aluminum greater than 25 ng/mL. Survival rates were similar for 16 patients who received parathyroidectomy and 47 who did not. An estimated 1-year survival rate of 61.6% was observed for 17 patients receiving surgical debridement compared with 27.4% for the 46 who did not (P = .008). LIMITATIONS: The study was limited by its retrospective design and there was no control group for the 15 nondialysis cases. CONCLUSIONS: Calciphylaxis is multifactorial and usually fatal. Prevention of calciphylaxis may include correction of risk factors identified in this study. Surgical debridement was associated with improved survival, but parathyroidectomy was not.
