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A soft tissue lesion on the scalp as a peculiar source of disseminated cryptococcosi
C H Ding1, A A Wahab1, N A Abd Rahman1
1Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Abstract:
Cryptococcosis is a potentially fatal invasive fungal infection with considerable health challenges. A seemingly immunocompetent middle-aged man with frequent exposure to pigeons and bird excreta presented with headaches, fever, gait instability and diplopia. Two years prior to his presentation, he sustained a blunt head trauma which resulted in sporadic headaches. On examination, a hard scalp nodule measuring approximately 3 x 3 cm was palpable on the topmost part of his head. Cryptococcus neoformans was cultured from his cerebrospinal fluid, blood and the biopsied scalp nodule. A diagnosis of disseminated cryptococcosis was made, with the scalp lesion being designated as the primary source of the infection. Following a protracted course of antifungal therapy lasting 10 weeks, the patient was asymptomatic without any neurological deficits when reviewed in the clinic at two months post discharge.
Insights
This case study highlights a rare instance of disseminated cryptococcosis in an immunocompetent man, originating from a scalp lesion. Prompt antifungal treatment led to a full recovery without neurological deficits.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Cryptococcosis is a serious fungal infection, often opportunistic.
- Disseminated cases can be fatal, posing significant clinical challenges.
- Scalp lesions as a primary source of disseminated cryptococcosis are rare.
Purpose of the Study:
- To report a unique case of disseminated cryptococcosis.
- To highlight the potential for unusual primary infection sites.
- To emphasize the importance of considering fungal infections in seemingly immunocompetent individuals.
Main Methods:
- Clinical presentation and examination of a middle-aged male patient.
- Diagnostic workup including cerebrospinal fluid, blood, and scalp nodule cultures.
- Treatment with a 10-week course of antifungal therapy.
Main Results:
- Isolation of Cryptococcus neoformans from CSF, blood, and a scalp nodule.
- Diagnosis of disseminated cryptococcosis with the scalp lesion as the primary source.
- Successful treatment with complete resolution of symptoms and no neurological deficits.
Conclusions:
- Disseminated cryptococcosis can occur in immunocompetent hosts.
- Scalp lesions may serve as an unusual primary site for fungal dissemination.
- Early diagnosis and comprehensive antifungal therapy are crucial for favorable outcomes.
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