By Gary M. White, MD
Cryptococcosis is a granulomatous fungal infection caused by Cryptococcus neoformans. Both primary and secondary cryptococossis occur although primary (direct inoculation) is rare.
- Secondary or disseminated occurs after the organism is inhaled, infects the lungs and then disseminates to any part of the body.
- Approximately 10-15% of cases have cutaneous involvement.
- Most commonly associated with immunocompromised patients, e.g. HIV infection.
- A saprophyte commonly found in soil rich in pigeon droppings. May also be found in tree bark, e.g. eucalyptus.
Typical lesions include vegetative plaques, molluscum-like lesions, ulcers, abscesses and cellulitis-like. A typical history for primary infection is that of a vegetative or ulcerative lesion growing for months to years, and resistant to treatment with oral antibiotics and topical steroids.
Biopsy may show small thin-walled yeast with budding reproduction, which stain with colloidal iron and Grocott methenamine silver.
Consultation with an infectious disease specialist is in order. In the past for severe disease, Amphotericin B with or without IV flucytosine followed by oral fluconazole has been used. For milder disease, oral fluconazole or itraconazole has been used.
Renal transplant patient with an ulcerated plaque on the face for 2 weeks. J Am Acad Dermatology 63; 1; 177–179, July 201
Erythema with subcutaneous induration. Acta Dermato-Venereologica 2011;91;199
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