1887

Abstract

Introduction:

is an encapsulated budding yeast that is a common cause of opportunistic infections, rarely giving rise to cellulitis, vasculitis or fasciitis. Necrotizing fasciitis caused by is a rare but serious problem in post‐transplant immunosuppression.

Case presentation:

We report a case of cryptococcal necrotizing fasciitis in the left adductor longus of a patient on immunosuppressive therapy. The patient’s medical history was significant for orthotopic heart transplant secondary to cardiac and systemic amyloidosis (AL type) with subsequent cardiac biopsy demonstrating mild rejection (grade 1R). A thigh muscle biopsy demonstrated numerous encapsulated fungi in the fascia and no evidence of myositis. Cryptococcal antigen was subsequently identified in the patient’s serum and cerebrospinal fluid. The patient progressed to involvement of the central nervous system, left biceps femoris and skin of the left lower leg by fluconazole‐resistant .

Conclusion:

This case illustrates a rare initial presentation of disseminated fluconazole‐resistant as an isolated necrotizing fasciitis of the thigh. Necrotizing fungal fasciitis should be considered in immunosuppressed patients with clinical findings of either myositis or cellulitis of a lower extremity.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.003608-0
2014-12-01
2021-01-26
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/1/4/jmmcr003608.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.003608-0&mimeType=html&fmt=ahah

References

  1. Adachi M., Tsuruta D., Imanishi H., Ishii M., Kobayashi H.. ( 2009;). Necrotizing fasciitis caused by Cryptococcus neoformans in a patient with pemphigus vegetans. Clin Exp Dermatol34:e751–e753[CrossRef]
    [Google Scholar]
  2. Baer S., Baddley J.W., Gnann J.W., Pappas P.G.. ( 2009;). Cryptococcal disease presenting as necrotizing cellulitis in transplant recipients. Transpl Infect Dis11:353–358[CrossRef]
    [Google Scholar]
  3. Basaran O., Emiroglu R., Arikan U., Karakayali H., Haberal M.. ( 2003;). Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities. Dermatol Surg29:1158–1160
    [Google Scholar]
  4. Begon E., Bachmeyer C., Thibault M., Boulet E., Staub G., Trouillet G., Testart F., Blum L.. ( 2009;). Necrotizing fasciitis due to Cryptococcus neoformans in a diabetic patient with chronic renal insufficiency. Clin Exp Dermatol34:935–936[CrossRef]
    [Google Scholar]
  5. Buchanan P.J., Mast B.A., Lottenberg L., Kim T., Efron P.A., Ang D.N.. ( 2013;). Candida albicans necrotizing soft tissue infection: a case report and literature review of fungal necrotizing soft tissue infections. Ann Plast Surg70:739–741[CrossRef]
    [Google Scholar]
  6. Chayakulkeeree M., Perfect J.R.. ( 2006;). Cryptococcosis. Infect Dis Clin North Am20:507544 v–vi[CrossRef]
    [Google Scholar]
  7. Crum‐Cianflone N.F.. ( 2008;). Bacterial, fungal, parasitic, and viral myositis. Clin Microbiol Rev21:473–494[CrossRef]
    [Google Scholar]
  8. Giuliano A., Lewis F. Jr, Hadley K., Blaisdell F.W.. ( 1977;). Bacteriology of necrotizing fasciitis. Am J Surg134:52–57[CrossRef]
    [Google Scholar]
  9. Huang K.C., Tu Y.K., Lee K.F., Huang T.J., Wen‐Wei Hsu R.. ( 2007;). Disseminated cryptococcosis presented as necrotizing fasciitis of a limb. J Trauma63:E44–E46[CrossRef]
    [Google Scholar]
  10. Jain D., Kumar Y., Vasishta R.K., Rajesh L., Pattari S.K., Chakrabarti A.. ( 2006;). Zygomycotic necrotizing fasciitis in immunocompetent patients: a series of 18 cases. Mod Pathol19:1221–1226[CrossRef]
    [Google Scholar]
  11. Kimura M., Kadota E., Satou T., Yoneda E., Furuta T.. ( 2001;). Case report. Cryptococcal cellulitis showing necrotizing vasculitis. Mycoses44:115–118[CrossRef]
    [Google Scholar]
  12. Kotrappa K.S., Bansal R.S., Amin N.M.. ( 1996;). Necrotizing fasciitis. Am Fam Physician53:1691–1697
    [Google Scholar]
  13. Marcus J.R., Hussong J.W., Gonzalez C., Dumanian G.A.. ( 1998;). Risk factors in necrotizing fasciitis: a case involving Cryptococcus neoformans . Ann Plast Surg40:80–83[CrossRef]
    [Google Scholar]
  14. Mitchell T.G., Perfect J.R.. ( 1995;). Cryptococcosis in the era of AIDS‐100 years after the discovery of Cryptococcus neoformans . Clin Microbiol Rev8:515–548
    [Google Scholar]
  15. Murakawa G.J., Kerschmann R., Berger T.. ( 1996;). Cutaneous Cryptococcus infection and AIDS. Report of 12 cases and review of the literature. Arch Dermatol132:545–548[CrossRef]
    [Google Scholar]
  16. Perfect J.R.. ( 2012;). The triple threat of cryptococcosis: it’s the body site, the strain, and/or the host. MBio3:e00165–12[CrossRef]
    [Google Scholar]
  17. Saag M.S., Graybill R.J., Larsen R.A., Pappas P.G., Perfect J.R., Powderly W.G., Sobel J.D., Dismukes W.E.. ( 2000;). Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis30:710–718[CrossRef]
    [Google Scholar]
  18. Sewry C.A., Jimenez‐Mallebrera C., Brown S.C., Muntoni F.. ( 2008;). Diseases of Muscle. In Greenfield’s Neuropathology 8th edn, pp1725–1820 Greenfield J G, Love S, Louis D N. Ellison D. London: Hodder Arnold;
    [Google Scholar]
  19. Shrader S.K., Watts J.C., Dancik J.A., Band J.D.. ( 1986;). Disseminated cryptococcosis presenting as cellulitis with necrotizing vasculitis. J Clin Microbiol24:860–862
    [Google Scholar]
  20. Spiliopoulou A., Anastassiou E.D., Christofidou M.. ( 2012;). Primary cutaneous cryptococcosis in immunocompetent hosts. Mycoses55:e45–e47[CrossRef]
    [Google Scholar]
  21. Tseng H.K., Liu C.P., Price M.S., Jong A.Y., Chang J.C., Toffaletti D.L., Betancourt‐Quiroz M., Frazzitta A.E., Cho W.L.. other authors( 2012;). Identification of genes from the fungal pathogen Cryptococcus neoformans related to transmigration into the central nervous system. PLoS One7:e45083[CrossRef]
    [Google Scholar]
  22. Wang J.M., Lim H.K.. ( 2014;). Necrotizing fasciitis: eight‐year experience and literature review. Braz J Infect Dis18:137–143[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.003608-0
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.003608-0
Loading

Data & Media loading...

Most cited this month 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