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Cryptococcus-like changes in the setting of vasculitis.

Amber Fresco1, Jenny Wang2, Aimee Krausz1

  • 1Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.

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|October 27, 2018
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Summary

Cutaneous vasculitis can mimic fungal infections, presenting diagnostic challenges. This study identifies unusual yeast-like cells in vasculitis, distinct from fungi, aiding accurate diagnosis and treatment.

Keywords:
ANCAcryptococcoidmimicneutrophilic dermatosisvasculitis

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Area of Science:

  • Dermatology
  • Pathology
  • Immunology

Background:

  • Cutaneous vasculitis presents diverse clinical and histological features, often overlapping with infections.
  • Accurate differentiation between vasculitis and infection is crucial for appropriate patient management.

Observation:

  • Two patients presented with generalized polymorphous eruptions.
  • Histopathology revealed vasculitis with unusual haloed yeast-like cells, mimicking fungal elements.
  • These cells were negative for fungal stains but positive for CD68 and myeloperoxidase (MPO).

Findings:

  • Both patients had positive serum anti-MPO antibodies.
  • One patient had a fatal outcome; the other improved with corticosteroid treatment.
  • The second patient's prior biopsy showed Sweet syndrome with cryptococcoid-appearing cells.

Implications:

  • These cases highlight cryptococcoid mimickers in vasculitis, expanding the differential diagnosis.
  • The findings emphasize the importance of immunophenotyping for distinguishing vasculitis from infection.
  • Early recognition and treatment of anti-MPO-associated vasculitis are critical for patient outcomes.