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Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion

Ragini Tilak1, Pradyot Prakash, Chaitanya Nigam

  • 1Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi. raginijain29@rediffmail.com

Dermatology Online Journal
|November 26, 2009
PubMed

Insights

Primary cutaneous cryptococcosis, a skin infection by Cryptococcus neoformans, can spread to the central nervous system. Early diagnosis via Gram stain or India ink can prevent fatal meningitis in HIV-negative individuals.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Dermatology

Background:

  • Cutaneous cryptococcosis, caused by Cryptococcus neoformans, typically indicates systemic infection.
  • Primary cutaneous infection without systemic involvement is less common.

Observation:

  • A 17-year-old, HIV-negative boy presented with a chronic non-healing ulcer on his toe and symptoms of meningitis.
  • Cryptococcus neoformans var. gattii was identified in the cerebrospinal fluid (CSF).

Findings:

  • The patient experienced recovery from both meningitis and the cutaneous ulcer following Amphotericin B treatment.
  • This case highlights primary cutaneous cryptococcosis with subsequent central nervous system (CNS) dissemination.

Implications:

  • Prompt diagnosis of primary cutaneous cryptococcosis using simple stains (Gram stain, India ink) is crucial.
  • Early intervention can prevent disseminated disease, including potentially fatal cryptococcal meningitis.
  • This case underscores the importance of considering cutaneous infections as potential entry points for systemic fungal spread, even in immunocompetent individuals.

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