Disseminated Papulopustular Candidiasis in an Immunocompetent adult: A case report

Candidiasis represents the most prevalent human fungal infection, originating from either endogenous colonization or exogenous acquisition, and encompasses a wide clinical spectrum ranging from localized mucocutaneous disease to disseminated, life-threatening infection. Extensive cutaneous candidiasis constitutes a relatively underrecognized and underreported manifestation, often overlooked in clinical practice. Broadly, Candida infections are classified into invasive disease (deep-seated involvement with or without candidemia) and mucocutaneous forms. Progression of extensive cutaneous candidiasis to deep-seated invasive infection remains exceedingly uncommon, particularly among immunocompetent adult hosts.

We report the case of a 52-year-old male who presented with extensive papulopustular lesions involving the scalp, neck, and abdomen, accompanied by febrile illness. During the course of hospitalization, he subsequently developed a cavitary pulmonary lesion and bilateral visual impairment, which was later attributed to Candida chorioretinitis. Repeated cultures from cutaneous lesions and bronchoalveolar lavage specimens yielded Candida albicans. The patient was initiated on intravenous liposomal amphotericin B, administered systemically, intradermally, and intravitreally, in combination with posaconazole. He was later transitioned to posaconazole maintenance therapy, which resulted in complete resolution of both cutaneous and pulmonary lesions.

This case highlights disseminated papulopustular candidiasis as an uncommon initial manifestation of invasive Candida infection. Prompt recognition and the institution of aggressive antifungal therapy are essential to optimize clinical outcomes.