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Cryptococcosis during systemic glucocorticosteroid treatment.
A I Lauerma1, L Jeskanen, T Rantanen
1Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland.
Dermatology (Basel, Switzerland)
|November 13, 1999
Summary
A patient with sarcoidosis developed a skin infection caused by Cryptococcus neoformans (cryptococcosis) while on long-term steroid treatment. Early diagnosis and combination antifungal therapy led to successful recovery.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- Cryptococcosis is an opportunistic fungal infection primarily affecting immunocompromised individuals.
- Systemic glucocorticosteroids can increase the risk of opportunistic infections like cryptococcosis.
- Sarcoidosis is an inflammatory disease that may necessitate immunosuppressive therapy.
Observation:
- A patient with a 4-year history of lung sarcoidosis treated with systemic glucocorticosteroids developed a progressive papular and ulcerative skin eruption.
- Initial skin biopsies showed granulomatous inflammation, leading to a misdiagnosis of refractory sarcoidosis.
- Despite treatment for sarcoidosis, the skin lesions persisted and worsened over a year.
Findings:
- A second skin biopsy and fungal culture definitively identified Cryptococcus neoformans as the causative agent.
- Cryptococcal antigen detection in blood and cerebrospinal fluid confirmed disseminated infection.
- The patient's condition improved significantly with a combination of amphotericin B and flucytosine, followed by fluconazole maintenance therapy.
Implications:
- This case highlights the importance of considering opportunistic fungal infections in immunocompromised patients presenting with unusual dermatological manifestations.
- Prompt and accurate diagnosis of cryptococcosis is crucial for effective treatment and patient outcomes.
- Long-term immunosuppressive therapy requires vigilant monitoring for potential infectious complications.