Fatal primary cutaneous cryptococcosis: case report and review of published literature
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Published on: September 20, 2018
Y Liu1, H Qunpeng1, X Shutian1
1National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, China.
Objective:
Cryptococcus is an opportunistic yeast with a worldwide distribution that primarily causes significant infections in immunocompromised individuals, generally by affecting the respiratory tract. But primary cutaneous cryptococcosis (PCC) without systemic infection is rare. We report a case of PCC in a patient with nephrotic syndrome.
Methods:
The 23-year-old man developed severe necrotising cellulitis on both the anterior and posterior of his trunk following a massage. He had been treated with systemic corticosteroids over 20 months for nephrotic syndrome. A skin biopsy of the wound area revealed cutaneous vasculitis and chronic inflammation with yeast-like organisms. Periodic acid-Schiff (PAS) staining indicated that the structures were consistent with Cryptococcus. A Cryptococcus neoformans infection was confirmed by culture. Azole therapy was begun, and the skin ulcers gradually stopped disseminating. However, the patient died following continuous capillary haemorrhage on the 22 day since admission.
Conclusion:
Cryptococcus is crucial to be considered in the differential diagnosis of subcutaneous necrosis in any patient on immunosuppressive therapy.
Insights
Primary cutaneous cryptococcosis (PCC) is a rare infection in immunocompromised patients. This case highlights PCC in a patient with nephrotic syndrome, emphasizing the need for prompt diagnosis and treatment in similar cases.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Dermatology
Background:
- Cryptococcus is an opportunistic yeast causing infections, primarily in immunocompromised individuals.
- Primary cutaneous cryptococcosis (PCC), without systemic involvement, is an uncommon presentation.
- Nephrotic syndrome often requires immunosuppressive therapy, increasing susceptibility to infections.
