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Cryptococcal cellulitis in congenital lymphedema
N Krywonis1, V N Kaye, P J Lynch
1Department of Dermatology, University of Minnesota Hospital and Clinics, Minneapolis.
Insights
Cryptococcal cellulitis can occur in patients with weakened cell-mediated immunity, such as those with intestinal lymphangiectasia and lymphedema. Early antifungal treatment with amphotericin B and 5-fluorocytosine led to a successful recovery.
Area of Science:
- Medical Mycology
- Immunology
- Dermatology
Background:
- Intestinal lymphangiectasia and congenital lymphedema can compromise cell-mediated immunity.
- Cryptococcal infections, though typically systemic, can manifest in the skin.
Observation:
- A 27-year-old female patient presented with cryptococcal cellulitis.
- The patient had a history of intestinal lymphangiectasia and congenital lymphedema, predisposing her to immune dysfunction.
Findings:
- Prompt administration of amphotericin B and 5-fluorocytosine achieved an excellent clinical outcome.
- This case highlights a rare cutaneous manifestation of Cryptococcus in an immunocompromised host.
Implications:
- Increased prevalence of compromised cell-mediated immunity may lead to more cases of cryptococcal cellulitis.
- Physicians should consider fungal etiologies, including Cryptococcus, in the differential diagnosis of severe or atypical cellulitis.
- Early and appropriate antifungal therapy is crucial for favorable outcomes in cryptococcal skin infections.
Abstract:
A 27-year-old woman with intestinal lymphangiectasia and congenital lymphedema developed cryptococcal cellulitis as a result of her underlying depressed cell-mediated immune responsiveness. Prompt therapy with amphotericin B and 5-fluorocytosine resulted in an excellent outcome. The authors believe that the increasing population of patients with depression of cell-mediated immune response will lead to an increase in the frequency with which cryptococcal cellulitis is seen and emphasize that proper evaluation of a patient with presumptive cellulitis includes consideration of fungal, as well as bacterial, etiology.