Disseminated cryptococcal infection initially presenting as cryptococcal cellulitis in an HIV-negative patient on...

Area of Science:

• Mycology
• Infectious Diseases
• Dermatology

Background:

• Cryptococcosis is an invasive fungal infection caused by *Cryptococcus* species, typically acquired through inhalation.
• The infection can disseminate hematogenously to various organs, including the skin, particularly in immunocompromised hosts.
• Immunosuppression, such as long-term corticosteroid use, increases susceptibility to invasive fungal infections.

Observation:

• A 68-year-old male on long-term steroids presented with right upper limb cellulitis unresponsive to antibiotics.
• An urgent skin biopsy revealed cryptococcal cellulitis.
• Initial wound and blood cultures were negative, but repeat cultures confirmed disseminated cryptococcal disease.

Findings:

• Cryptococcal cellulitis can be an initial manifestation of disseminated cryptococcosis.
• Repeated microbiological investigations are crucial for diagnosing disseminated fungal infections, especially when initial tests are negative.
• Environmental exposure, such as proximity to racing pigeons, is a potential source for *Cryptococcus* transmission.

Implications:

• This case underscores the need to consider fungal etiologies in refractory skin infections, particularly in immunocompromised patients.
• Early and accurate diagnosis of cryptococcal cellulitis is vital for timely initiation of antifungal therapy to prevent dissemination.
• Public health awareness regarding potential environmental sources of fungal pathogens like *Cryptococcus* is important for prevention strategies.