Cutaneous cryptococcosis in an adult male of sub-saharan origin

Area of Science:

• Medical Mycology
• Infectious Diseases
• Dermatology

Background:

• Cryptococcosis is a fungal infection caused by inhaling Cryptococcus yeast or basidiospores.
• It can disseminate hematogenously, leading to severe manifestations like meningoencephalitis, particularly in sub-Saharan Africa.
• Cutaneous lesions may arise from direct inoculation or disseminated disease, often mimicking other conditions.

Observation:

• A 34-year-old, HIV-positive, antiretroviral therapy-naive male presented with a low CD4 count and high viral load.
• He was referred to dermatology for multiple, 3-5 mm, umbilicated, skin-colored lesions on his nose.
• The differential diagnosis for such lesions is broad, including other infections and neoplasms.

Findings:

• Punch biopsy, India ink staining, and Sabouraud dextrose agar culture were performed.
• These diagnostic methods confirmed the presence of *Cryptococcus neoformans* as the causative agent.
• The patient's presentation highlighted cryptococcosis as an opportunistic infection in an immunocompromised individual.

Implications:

• Early and accurate diagnosis of cutaneous cryptococcosis is crucial for timely treatment.
• Recognition of these lesions in HIV-positive patients is vital for managing disseminated disease.
• This case underscores the importance of considering fungal infections in the differential diagnosis of dermatological presentations in immunocompromised individuals.