Primary Cutaneous Cryptococcosis in an Older Immunocompetent Patient: A Case Report

Cryptococcus neoformans is an encapsulated yeast that can be found in pigeon droppings, hay, and dust. Primary cutaneous cryptococcosis (PCC) without systemic involvement is recognized as a distinct clinical condition and is rarely reported in immunocompetent patients. A 78-year-old woman with no history of other diseases except for hypertension presented with a painful diffuse erythematous plaque along with oozing on left forearm that had lasted for 7 weeks. She was treated with cefoperazone/sulbactam for 3 weeks under suspicion of bacterial cellulitis, although the lesions aggravated without any improvement. We performed bacterial and fungal cultures as well as incisional biopsy. The pathogen was identified as Cryptococcus neoformans following sequence analysis of the internal transcribed spacer gene. The patient was treated with fluconazole 400 mg/day for 3 months, and there was no evidence of recurrence after 3 months of follow-up.