1887

JMM Case Reports

Volume 1, Issue 3

Primary cutaneous cryptococcosis and a surprise finding in a chronically immunosuppressed patient Open Access

Abstract

Introduction:

Primary cutaneous cryptococcosis is a rare form of cryptococcosis occurring after direct inoculation of spp. yeast cells through skin injury and equally affects immunocompetent and immunocompromised individuals.

Case presentation:

We report a case of a 61‐year‐old man who presented with an 8‐month history of an ulcerative lesion on a finger, which was refractory to antimicrobials, following injury with a plant thorn. The patient had a medical history of myasthenia gravis and had been undergoing treatment with pyridostigmine and intermediate doses of prednisolone for more than 30 years. A skin‐lesion culture was positive for var. , which was molecularly confirmed and typed as serotype D, mating‐type α, genotype AFLP2/VNIV. Histopathology revealed a diffuse type of inflammation, with many yeasts consistent with spp. The serum cryptococcal antigen was positive at a titre of 1 : 32. Radiological investigation excluded disseminated disease but revealed the incidental presence of a clear cell renal cell carcinoma. The tumour was considered to be an additional factor of immunosuppression and could justify the histological findings. The patient was treated with 200 mg fluconazole twice daily, underwent surgical removal of the mass and received treatment with sunitinib, a receptor protein‐tyrosine kinase inhibitor. At the 4 month follow‐up, he had a remarkable clinical improvement. A year after, he remained symptom free and tolerated the anti‐tumour therapy well.

Conclusion:

The patient presented here had no evidence of a disseminated cryptococcal infection despite two concurrent causes of cellular immunity defect and a positive antigen titre.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Cryptococcus neoformans , cutaneous ulcer , fluconazole , prednisolone , primary cutaneous cryptococcosis and renal carcinoma
© 2014 The Authors
  • This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.003426
2014-09-01
2024-04-23
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/1/3/jmmcr003426.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.003426&mimeType=html&fmt=ahah

References

  1. Anderson D.J., Schmidt C., Goodman J., Pomeroy C. ( 1992). Cryptococcal disease presenting as cellulitis. Clin Infect Dis 14:666–672 [CrossRef]
     [Google Scholar]
  2. Arsic Arsenijevic V., Pekmezovic M.G., Meis J.F., Hagen F. ( 2014). Molecular epidemiology and antifungal susceptibility of Serbian Cryptococcus neoformans isolates. Mycoses 57:380–387
     [Google Scholar]
  3. Baumgarten K.L., Valentine V.G., Garcia‐Diaz J.B. ( 2004). Primary cutaneous cryptococcosis in a lung transplant recipient. South Med J 97:692–695 [CrossRef]
     [Google Scholar]
  4. Bellosta M., Gaviglio M.R., Mosconi M., Cavanna C., Viglio A., Rabbiosi G. ( 1999). Primary cutaneous cryptococcosis in an HIV‐negative patient. Eur J Dermatol 9:224–226
     [Google Scholar]
  5. Biswas S., Biswas K., Richmond A., Ko J., Ghosh S., Simmons M., Rayman P., Rini B., Gill I. other authors( 2009). Elevated levels of select gangliosides in T cells from renal cell carcinoma patients is associated with T cell dysfunction. J Immunol 183:5050–5058 [CrossRef]
     [Google Scholar]
  6. Chayakulkeeree M., Perfect J.R. ( 2006). Cryptococcosis. Infect Dis Clin North Am 20, 507–544, v–vi
    [Google Scholar]
  7. Christianson J.C., Engber W., Andes D. ( 2003). Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol 41:177–188 [CrossRef]
     [Google Scholar]
  8. Das T., Sa G., Hilston C., Kudo D., Rayman P., Biswas K., Molto L., Bukowski R., Rini B. other authors( 2008a). GM1 and tumor necrosis factor‐α, overexpressed in renal cell carcinoma, synergize to induce T‐cell apoptosis. Cancer Res 68:2014–2023 [CrossRef]
     [Google Scholar]
  9. Das T., Sa G., Paszkiewicz‐Kozik E., Hilston C., Molto L., Rayman P. other authors( 2008b). Renal cell carcinoma tumors induce T cell apoptosis through receptor‐dependent and receptor‐independent pathways. J Immunol 180:4687–4696 [CrossRef]
     [Google Scholar]
  10. Fallah H., Watson A., Henderson C.J., Woodford P., Bothman J., McCrossin I. ( 2011). Cryptococcosis presenting as upper limb cellulitis and ulceration: a case series. Australas J Dermatol 52:288–291 [CrossRef]
     [Google Scholar]
  11. Fonseca Á., Boekhout T., Fell J.W. ( 2011). Cryptococcus Vuillemin (1901). In The Yeasts, a Taxonomic Study, 5th. edn, pp. 1661–1737 Edited by Kurtzman C. P., Fell J. W., Boekhout T. Amsterdam: Elsevier; [CrossRef]
     [Google Scholar]
  12. Hafner C., Linde H.J., Vogt T., Breindl G., Tintelnot K., Koellner K., Landthaler M., Szeimies R.M. ( 2005). Primary cutaneous cryptococcosis and secondary antigenemia in a patient with long‐term corticosteroid therapy. Infection 33:86–89 [CrossRef]
     [Google Scholar]
  13. Hay R.J. ( 1985). Cryptococcus neoformans and cutaneous cryptococcosis. Semin Dermatol 4:252–259
     [Google Scholar]
  14. Ingleton R., Koestenblatt E., Don P., Levy H., Szaniawski W., Weinberg J.M. ( 1998). Cutaneous cryptococcosis mimicking basal cell carcinoma in a patient with AIDS. J Cutan Med Surg 3:43–45
     [Google Scholar]
  15. Jasch K.C., Hermes B., Scheller U., Harth W. ( 2008). Pyoderma gangrenosum‐like primary cutaneous cryptococcosis. Acta Derm Venereol 88:76–77 [CrossRef]
     [Google Scholar]
  16. Kwon‐Chung K.J., Sorrell T.C., Dromer F., Fung E., Levitz S.M. ( 2000). Cryptococcosis: clinical and biological aspects. Med Mycol 38:Suppl. 1205–213 [CrossRef]
     [Google Scholar]
  17. Lacaz Cda S., Heins‐Vaccari E.M., Hernandez‐Arriagada G.L., Martins E.L., Prearo C.A., Corim S.M., Martins Mdos A. ( 2002). Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B, in an immunocompetent patient. Rev Inst Med Trop Sao Paulo 44:225–228 [CrossRef]
     [Google Scholar]
  18. Lafleur L., Beaty S., Colome‐Grimmer M.I., LaForte R.A., Dotson A.D. ( 2004). Cryptococcal cellulitis in a patient on prednisone monotherapy for myasthenia gravis. Cutis 74:165–170
     [Google Scholar]
  19. Lu H.C., Yang Y.Y., Huang Y.L., Chen T.L., Chuang C.L., Lee F.Y., Lee S.D. ( 2007). Disseminated cryptococcosis initially presenting as cellulitis in a rheumatoid arthritis patient. J Chin Med Assoc 70:249–252 [CrossRef]
     [Google Scholar]
  20. Miura T., Akiba H., Saito N., Seiji M. ( 1971). Primary cutaneous cryptococcosis. Dermatologica 142:374–379 [CrossRef]
     [Google Scholar]
  21. Neuville S., Dromer F., Morin O., Dupont B., Ronin O., Lortholary O. the French Cryptococcosis Study Group( 2003). Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis 36:337–347 [CrossRef]
     [Google Scholar]
  22. Ng W.F., Loo K.T. ( 1993). Cutaneous cryptococcosis – primary versus secondary disease. Report of two cases with review of literature. Am J Dermatopathol 15:372–377 [CrossRef]
     [Google Scholar]
  23. Noble R.C., Fajardo L.F. ( 1972). Primary cutaneous cryptococcosis: review and morphologic study. Am J Clin Pathol 57:13–22
     [Google Scholar]
  24. Park B.J., Wannemuehler K.A., Marston B.J., Govender N., Pappas P.G., Chiller T.M. ( 2009). Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 23:525–530 [CrossRef]
     [Google Scholar]
  25. Perfect J.R., Seaworth B.A. ( 1985). Penile cryptococcosis with review of mycotic infections of penis. Urology 25:528–531 [CrossRef]
     [Google Scholar]
  26. Perfect J.R., Dismukes W.E., Dromer F., Goldman D.L., Graybill J.R., Hamill R.J., Harrison T.S., Larsen R.A., Lortholary O. other authors( 2010). Clinical practice guidelines for the management of cryptococcal disease: update by the Infectious Diseases Society of America. Clin Infect Dis 50:291–322 [CrossRef]
     [Google Scholar]
  27. Pietras T.A., Baum C.L., Swick B.L. ( 2010). Coexistent Kaposi sarcoma, cryptococcosis, and Mycobacterium avium intracellulare in a solitary cutaneous nodule in a patient with AIDS: report of a case and literature review. J Am Acad Dermatol 62:676–680 [CrossRef]
     [Google Scholar]
  28. Posada C., de la Torre C., Gonzalez‐Sixto B., Cruces M.J. ( 2009). Primary cutaneous cryptococcosis presenting with a sporotrichoid pattern in a cancer patient. Actas Dermosifiliogr 100:78–80 [CrossRef]
     [Google Scholar]
  29. Reisfeld‐Zadok S., Elis A., Szyper‐Kravitz M., Chowers M., Lishner M. ( 2009). Cryptococcal meningitis in chronic lymphocytic leukemia patients. Isr Med Assoc J 11:437–439
     [Google Scholar]
  30. Revenga F., Paricio J.F., Merino F.J., Nebreda T., Ramirez T., Martinez A.M. ( 2002). Primary cutaneous cryptococcosis in an immunocompetent host: case report and review of the literature. Dermatology 204:145–149 [CrossRef]
     [Google Scholar]
  31. Sarosi G.A., Silberfarb P.M., Tosh F.E. ( 1971). Cutaneous cryptococcosis. A sentinel of disseminated disease. Arch Dermatol; 104:1–3
     [Google Scholar]
  32. Singh N., Dromer F., Perfect J.R., Lortholary O. ( 2008). Cryptococcosis in solid organ transplant recipients: current state of the science. Clin Infect Dis 47:1321–1327 [CrossRef]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.003426
Loading
Primary cutaneous cryptococcosis and a surprise finding in a chronically immunosuppressed patient
JMM Case Rep 1, e003426 (2014); https://doi.org/10.1099/jmmcr.0.003426
/content/journal/jmmcr/10.1099/jmmcr.0.003426
/content/journal/jmmcr/10.1099/jmmcr.0.003426
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error