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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
Abstract:
Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome.
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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