1887

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.

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2014-09-01
2019-10-21
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