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Cryptococcal disease presenting as cellulitis.

D J Anderson1, C Schmidt, J Goodman

  • 1Pathology Department, University of Minnesota School of Medicine, Minneapolis.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 1, 1992
PubMed
Summary
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Cryptococcal disease can manifest as cellulitis in immunocompromised patients, often mistaken for bacterial infections. Early diagnosis and antifungal treatment are crucial for survival in these cases of cryptococcal cellulitis.

Area of Science:

  • Infectious Diseases
  • Dermatology
  • Mycology

Background:

  • Cryptococcal infections are a significant concern in immunocompromised individuals.
  • Cellulitis is a common skin infection, typically bacterial.
  • Cutaneous manifestations of Cryptococcus neoformans are known but cellulitis is rare.

Observation:

  • Three immunocompromised patients presented with cellulitis as the primary sign of cryptococcal disease.
  • Two patients were renal transplant recipients on immunosuppressants; one had intestinal lymphangiectasia with lymphopenia and hypoalbuminemia.
  • Initial treatment for presumed bacterial cellulitis was ineffective in all cases.

Findings:

  • Diagnosis was confirmed via skin biopsy or aspiration, revealing Cryptococcus neoformans.

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  • Two of the three patients survived after receiving systemic antifungal therapy.
  • Cryptococcal cellulitis suggests disseminated cryptococcal disease.

    • Implications:

    • Cryptococcus neoformans should be considered in the differential diagnosis of cellulitis in immunocompromised patients.
    • Prompt diagnosis and treatment of cryptococcal cellulitis can significantly reduce mortality.
    • This presentation highlights an underrecognized cutaneous manifestation of disseminated cryptococcosis.