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When in Doubt, Cut It Out: Biopsy as Key in Diagnosing Cryptococcal Soft Tissue Infection
Teresa Bernardes1, Lorena Ostilla1, Amara Fazal1
1Department of Medicine, South Miami Hospital, Baptist Health of South Florida, Miami, USA.
Insights
Cryptococcus infection rarely causes soft tissue infections without immunosuppression. This case highlights the importance of tissue biopsy for diagnosing atypical infections unresponsive to antibiotics.
Area of Science:
- Infectious Diseases
- Mycology
- Dermatology
Background:
- Cryptococcus infections typically manifest as pneumonia or meningitis, particularly in immunocompromised individuals.
- Soft tissue infections are rare presentations of Cryptococcus, especially without significant immunosuppression.
Observation:
- An 81-year-old woman with mild immunocompromise and comorbidities presented with an extensive thigh soft tissue infection.
- Initial cultures identified vancomycin-resistant Enterococcus, but antibacterial treatments were ineffective.
Findings:
- Tissue biopsy revealed abundant yeasts, with mucicarmine staining confirming Cryptococcus infection.
- The patient had no evidence of disseminated disease despite the extensive soft tissue involvement.
Implications:
- This case underscores the necessity of tissue biopsy and microbial cultures for diagnosing atypical skin and soft tissue infections.
- Prompt diagnosis and appropriate antifungal treatment (fluconazole) combined with surgical debridement led to complete resolution.
Abstract:
Soft tissue infection is an uncommon presentation of Cryptococcus in the absence of immunosuppression. Most infected patients present with pneumonia or meningitis, often with signs of disseminated disease, which may be fatal. We present a case of an 81-year-old mildly immunocompromised woman with multiple comorbidities, who presented with an extensive soft tissue infection on her right medial thigh. Superficial skin culture grew vancomycin-resistant Enterococcus; however, both initial and subsequent antibacterial therapies failed to resolve the infection. Subsequent biopsy revealed abundant yeasts, and mucicarmine staining confirmed Cryptococcus infection in a patient with no evidence of disseminated disease. Wound debridement and fluconazole for six months resulted in complete resolution of the lesion. In this report, we emphasize the need for tissue biopsy and microbial cultures in diagnosing patients with atypical skin and soft tissue infections who do not respond to appropriate antibiotics.
