Cutaneous cryptococosis: systemic or localized disease?
DOI:
https://doi.org/10.5935/2764-734X.e20230324Keywords:
Cryptococcosis, Invasive Fungal Infections, Cutaneous Manifestations., Case ReportAbstract
Cutaneous cryptococcosis is a fungal infection that can manifest as localized or disseminated disease in both immunocompetent and immunocompromised patients. The present report describes a case of an 81-year-old man from the rural area of Bahia, with the cutaneous form of the disease. Initially the patient was considered to have primary cryptococcosis and was treated with fluconazole. However, in order to rule out disseminated disease, the patient underwent chest tomography, which showed pulmonary nodules that, associated with positive antigenemia, justified the change to liposomal amphotericin B. There was a satisfactory clinical response with no evident complications related to the treatment, but a late metastatic prostate cancer diagnosis allowed to question the supposed fungal infection spread. The differentiation between localized and disseminated cryptococcosis is difficult, but it is fundamental for the proper direction of treatment.
References
1. Christanson JC, Engber W, Andes D. Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol J. 2003 Jun;41(3):177-88.
2. Du L, Yang Y, Gu J, Chen J, Liao W, Zhu Y. Systemic review of published reports on primary cutaneous cryptococcosis in immunocompetent patients. Mycopathologia. 2015 Aug;180(1-2):19-25.
3. Noguchi H, Matsumoto T, Kimura U, Hiruma M, Kusuhara M, Ihn H. Cutaneous cryptococcosis. Med Mycol J. 2019;60(4):101-7.
4. Marques SA, Bastazini Junior I, Martins AL, Barreto JA, Barbieri D’Elia MP, Lastória JC, et al. Primary cutaneous cryptococcosis in Brazil: report of 11 cases in immunocompetent and immunosuppressed patients. Int J Dermatol. 2012 Jul;51(7):780-4.
5. Ng WF, Loo KT. Cutaneous cryptococcosis – primary versus secondary disease: report of two cases and review of the literature. Am J Dermatopathol. 1993 Aug;15(4):372-7.
6. Tabassum S, Rahman A, Herekar F, Masood S. Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host. J Infect Dev Ctries. 2013 Sep;7(9):680-5.
7. Murakawa GJ, Kerschmann R, Berger T. Cutaneous Cryptococcus infection and AIDS: report of 12 cases and review of the literature. Arch Dermatol. 1996 May;132(5):545-8.
8. Pema K, Diaz J, Guerra LG, Nabhan D, Verghese A. Disseminated cryptococcosis: comparison of clinical manifestations in the pre-AIDS and AIDS era. Arch Intern Med. 1994 May;154(9):1032-4.
9. Amaral DM, Rocha RC, Carneiro LE, Vasconcelos DM, Abreu MA. Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms. An Bras Dermatol. 2016 Sep/Oct;91(5 Suppl 1):S29-S31.
10. Mayers DL, Martone WJ, Mandell GL. Cutaneous cryptococcosis mimicking gram-positive cellulitis in a renal transplant patient. South Med J. 1981 Aug;74(8):1032-3.
11. Lima AM, Rodrigues MM, Reis CMS. Cutaneous cryptococcosis mimicking leishmaniasis. Am J Trop Med Hyg. 2018 Jan;98(1):3-4.
12. Moretti ML, Resende MR, Lazéra MS, Colombo AL, Shikanai-Yasuda MA. Consenso em criptococose-2008. Rev Soc Bras Med Trop. 2008;41(5):524-44.
13. Miller Junior WT, Edelman JM, Miller WT. Cryptococcal pulmonary infections in patients with AIDS: radiographic appearance. Radiology. 1990 Jun;175(3):725-8.
14. Setianingrum F, Rautemaa-Richardson R, Denning DW. Pulmonary cryptococcosis: a review of pathobiology and clinical aspects. Med Mycol. 2019;57(2):133-50.
15. Limper AH. The changing spectrum of fungal infections in pulmonary and critical care practice: clinical approach to diagnosis. Proc Am Thorac Soc. 2010;7:163-8.
16. Swinne D, De Vroey C. Detection of circulating capsular polysaccharide antigenfrom Cryptococcus neoformans. J Clin Microbiol. 1992 Sep;30(9):2521.
17. Hafner C, Linde HJ, Vogt T, Breindl G, Tintelnot K, Koellner K, et al. Primary cutaneous cryptococcosis and secondary antigenemia in a patient with long-term corticosteroid therapy. Infection. 2005 Apr;33(2):86-9.
18. Nunez M, Peacock Junior JE, Chin Junior R. Pulmonary cryptococcosis in the immunocompetent host: therapy with oral fluconazole: a report of four cases and a review of the literature. Chest. 2000 Aug;118(2):527-34.
19. Neuville S, Dromer F, Morin O, Dupont B, Ronin O, Lortholary O. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis. 2003 Feb;36(3):337-47.
20. Yamaguchi H, Komase Y, Ikehara M, Yamamoto T, Shinagawa T. Disseminated cryptococcal infection with eosinophilia in a healthy person. J Infect Chemother. 2008 Aug;14(4):319-24.
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