Primary cutaneous cryptococcosis caused by Cryptococcus gattii in an immunocompetent host

Area of Science:

• Mycology
• Dermatology
• Infectious Diseases

Background:

• Cryptococcus gattii is an emerging fungal pathogen known to cause cryptococcosis.
• Primary cutaneous cryptococcosis is a rare manifestation, often associated with trauma and specific environmental exposures.
• Eucalyptus species are known environmental reservoirs for Cryptococcus gattii.

Observation:

• A 75-year-old Brazilian man presented with inflammatory skin lesions, nodules, and ulcerations on his forearm following an injury from barbed wire and Eucalyptus logs.
• Histopathology revealed granulomatous inflammation with yeasts resembling Cryptococcus spp.
• Fungal culture and molecular identification confirmed the presence of Cryptococcus gattii VGII.

Findings:

• The patient had no signs of systemic dissemination or immunosuppression, indicating primary cutaneous infection.
• Biochemical reactions and URA5-RFLP genotyping identified the causative agent as Cryptococcus gattii VGII.
• High-dose fluconazole therapy resulted in complete healing of the skin lesions within five months.

Implications:

• This case underscores the importance of considering environmental exposures, like handling Eucalyptus logs, in the diagnosis of cutaneous fungal infections.
• It highlights Cryptococcus gattii VGII as a potential cause of primary cutaneous disease, even in immunocompetent individuals.
• Successful treatment with fluconazole demonstrates its efficacy in managing primary cutaneous cryptococcosis.