ABSTRACT
An 82-year-old woman presented to our hospital with a deep skin ulcer in her right lower limb. Although the skin biopsy showed necrosis and neutrophil infiltration, we could not initially detect any pathogen. Chest radiography showed multiple nodules despite the lack of respiratory symptoms or fever, and the serum latex agglutination test for cryptococcus showed an elevated titer (1:512). Considering these findings, we performed additional stains of periodic acid-Schiff reaction and Grocott to the skin-biopsy specimen and detected multiple yeast-like fungi. The cultures of the skin and lung-biopsy specimens revealed Cryptococcus neoformans. In this case, it is suggested that a large deep skin ulcer can be an initial manifestation of systemic cryptococcosis, as, in some cases, pulmonary cryptococcosis may be asymptomatic. Second, cutaneous cryptococcosis of an unexposed area such as the thigh can contribute to the diagnosis of systemic cryptococcal infection because it is attributable to bloodstream dissemination from other organs.
Subject(s)
Cryptococcosis/diagnosis , Cryptococcosis/pathology , Cryptococcus neoformans/isolation & purification , Skin Ulcer/etiology , Skin Ulcer/pathology , Aged, 80 and over , Biopsy , Female , Histocytochemistry , Humans , Lower Extremity/pathology , Lung/pathology , Skin/pathologyABSTRACT
Se describe el caso clínico de una paciente de 55 años de edad, con aparente buen estado de salud hasta 6 meses antes de fallecer, quien comenzó a presentar cefalea crónica, que no mejoraba con el tratamiento, trastornos de la personalidad, confusión, neuropatía craneal, papiledema y coma profundo, sin respuesta al tratamiento antifúngico. Teniendo en cuenta los resultados del examen del líquido cefalorraquídeo se le diagnosticó una meningoencefalitis por Cryptococcus; asimismo el estudio anatomopatológico corroboró la existencia de criptococosis sistémica y sida.
The case report of a 55 year-old patient is described, with apparent good health up to 6 months before death who began to present chronic migraine which did not improve with treatment, personality disorders, confusion, cranial neuropathy, papilloedema and deep coma, without response to antifungal treatment. Keeping in mind the results of cerebrospinal liquid examination, a meningoencephalitis due to Cryptococcus was diagnosed; likewise the pathological study corroborated the existence of systemic cryptococcosis and AIDS.
