An Exceptional Case Report of Primary Cutaneous Cryptococcosis in Human Immunodeficiency Virus

Valan Valan

doi:10.3844/ajisp.2011.9.11

Abstract

Problem statement: Cryptococcosis is an infection caused by the encap sulated yeast Cryptococcus neoformans, a dimorphic fungus. In patients with AIDS, skin manifestations represent the second most common site of disseminated Cryptococcosis. Approach: Mr. A 42 year old farmer was referred from Voluntary Counseling and Testing Centre (VCTC) with positive HIV status to the outpatient department with one week history of asymptomatic discrete papular lesions over the face. Extirpation of the papule led to expression of the colorless watery material, which on Indian ink and Grams staining showed presence of Cryptococci and his CD4 count was found to be 58 cells cu.mm -1 . Sabourauds Dextrose Agar (SDA) culture of the material from the skin lesion revealed growth of Cryptococci. CSF, blood and sputum culture were negative for pathogens, Chest X-ray did not reveal any abnormal findings. Results: A diagnosis of primary Cutaneous Cryptococcosis was made and the patient was treated with Intravenous Amphotericin B followed by oral Fluconazole along with other supportive measures and Anti retroviral therapy. He showed remarkable improvement following therapy. Conclusion: In advanced stages of Immunodeficiency, patients may present only with umbilicated papules without any associated constitu tional symptoms. High degree of clinical suspicion, thorough history, detailed clinical exam ination and appropriate laboratory investigations a re needed to diagnose primary cutaneous cryptococcosis as these lesions may be misdiagnosed as Molluscum Contagiosum.

Highlights

MATERIALS AND METHODSCryptococcosis is an infectious disease that usually affects the respiratory tract and subsequently disseminates to other systems such as central nervous system and urinary tract (Cohen et al, 2010)
In HIV-infected patients, cryptococcosis is typically seen when the CD4 count is less than 50100 cells μL−1 and is an AIDS-defining illness (National AIDS Control Organization, 2007)
15% of the patients with systemic dissemination of Cryptococcosis have secondary involvement of the skin (Dharmshale et al, 2006) but primary Cutaneous Cryptococcosis is a rare manifestation in HIV

Summary

MATERIALS AND METHODS

Cryptococcosis is an infectious disease that usually affects the respiratory tract and subsequently disseminates to other systems such as central nervous system and urinary tract (Cohen et al, 2010). In HIV-infected patients, cryptococcosis is typically seen when the CD4 count is less than 50100 cells μL−1 and is an AIDS-defining illness (National AIDS Control Organization, 2007). On gram stain showed (Fig. 2) budding yeasts and on Indian ink showed presence of Cryptococci. This watery material from the papules inoculated and cultured in Sabouraud Dextrose Agar (SDA) after 4 days grew white-creamy and shiny colonies of Cryptococci at room temperature (Fig. 3). Microscopy and culture of blood, Cerebro spinal fluid and sputum did not yield any Cryptococcal organism. His CD4 count was 58 cells cu.mm−1. Immunol., 7 (1): 9-11, 2011 administered after Intravenous Amphotericin B as per national Opportunistic Infection guidelines 2007

Findings

DISCUSSION

CONCLUSION