Disseminated crytococcosis with extensive cutaneous involvement in AIDS

Area of Science:

• Medical Mycology
• Infectious Diseases
• Dermatology

Background:

• Disseminated cryptococcosis is a serious opportunistic infection in individuals with Acquired Immunodeficiency Syndrome (AIDS).
• Cutaneous manifestations occur in approximately 15% of patients with disseminated cryptococcosis, often presenting as non-specific lesions.
• Early and accurate diagnosis is crucial for effective management and improved patient outcomes.

Observation:

• A 34-year-old female with AIDS presented with multiple, skin-colored, umbilicated lesions on her face, neck, trunk, and limbs.
• The cutaneous lesions clinically resembled molluscum contagiosum and Kaposi sarcoma, highlighting a diagnostic challenge.
• Diagnostic workup included excision biopsy of skin lesions, mycological culture, cerebrospinal fluid (CSF) analysis, and cryptococcal antigen testing.

Findings:

• *Cryptococcus neoformans* was isolated and identified from both cutaneous lesions and CSF.
• High titer of cryptococcal antigen (1:1024) was detected in serum and CSF.
• The patient had a CD4 lymphocyte count of 80 cells/cmm and a high HIV viral load (2,48,084 copies/mL), confirming advanced immunodeficiency.

Implications:

• This case underscores the importance of considering fungal infections, specifically cryptococcosis, in the differential diagnosis of skin lesions in immunocompromised patients, particularly those with AIDS.
• Prompt initiation of appropriate antifungal therapy, such as amphotericin B and fluconazole, led to clinical improvement and regression of lesions.
• Highlighting the diverse clinical presentations of cryptococcosis emphasizes the need for high clinical suspicion and thorough diagnostic evaluation in at-risk populations.