Primary Cutaneous Cryptococcosis Research Articles

Primary Cutaneous Cryptococcosis Caused by Cryptococcus Neoformans in an Immunocompetent Patient

Cryptococcosis is a fungal infection caused by Cryptococcus species, most commonly affecting immunocompromised individuals, while very few cases of the infection in immunocompetent hosts are available in the literature. In this manuscript, we present a case of primary cutaneous cryptococcosis caused by Cryptococcus neoformans in an immunocompetent patient. While cutaneous manifestation is usually a secondary sign of the disseminated disease, our patient presented with primary cutaneous cryptococcosis. Additionally, reports on cryptococcosis cases suggest that immunocompetent hosts are typically infected by C. gattii. However, culture of the discharge from our immunocompetent patient showed heavy growth of C. neoformans. This case highlights the importance of considering cutaneous cryptococcosis as differential diagnosis of ulcerated skin lesions in patients with an exposure to bird droppings, regardless of their immune status and systemic manifestations.

Primary Cutaneous Cryptococcosis Caused by Cryptococcus neoformans in an Immunocompetent Patient

Background: Primary Cutaneous Cryptococcosis (PCC) is an uncommon disease restricted to cutaneous tissues caused by Cryptococcus spp. Case-report: We report a PCC case in a patient without any underlying disease. A 44-year-old man from Southern Brazil was referred to the hospital with 3-year recurrent skin lesions. A biopsy showed typical rounded and encapsulated blastoconidia typical of Cryptococcus and C. neoformans was identified in culture. Treatment with fluconazole (600 mg/day) was prescribed with improvement of the lesions. During the follow-up a self-reported interruption of treatment was detected and after 1 year of treatment, complete clinical cure was not yet achieved. Conclusion: This uncommon case reinforces the importance of mycologic examinations for correct diagnoses.

Primary cutaneous cryptococcosis presenting as ulcers in solid organ transplant recipient.

Primary cutaneous cryptococcosis presenting as ulcers in solid organ transplant recipient.

BI04 Cutaneous cryptococcosis: a post-transplant cat among the pigeons

Abstract Cryptococcosis is an infection caused by the encapsulated yeasts Cryptococcus neoformans and Cryptococcus gattii, which are opportunistic pathogens that mainly affect immunocompromised individuals. Infection is primarily by inhalation and causes pulmonary disease; haematogenous dissemination may affect other organs, particularly the central nervous system, with 10% of disseminated cryptococcosis affecting the skin. Primary cutaneous cryptococcosis due to direct skin inoculation is less common and rarely disseminates. We describe a kidney transplant recipient with disseminated cryptococcosis who presented with skin lesions in the early post-transplant period. As previously observed in a transplant patient with primary cutaneous cryptococcosis under our care, we propose that a history of close contact with urban pigeons was the source of infection. A 48-year-old man who had been transplanted in 2014 presented in May 2022 with a 3-cm-diameter, well-demarcated ulcer on his right shoulder which had been slowly enlarging over 6 weeks in close proximity to his recent COVID-19 vaccination site. Swab was positive for C. neoformans, serology was positive for cryptococcal antigen, chest X-ray showed a 14-mm nodule in the right lung and magnetic resonance imaging of the brain was normal. He was admitted by the transplant team and treated for presumed disseminated cryptococcal infection with intravenous AmBisome® and flucytosine for 2 weeks, and subsequently oral fluconazole. In view of his atypical presentation, we directly questioned him about previous skin disorders and possible sources of infection. It emerged that 6 months earlier, he had noticed multiple lesions on his legs but did not report this as they spontaneously resolved. Mobile phone images showed 0.5–1-cm umbilicated, red–purple nodules consistent with possible primary cutaneous cryptococcosis. We discovered that his balcony was covered in pigeons and their droppings, and he had unsuccessfully asked his local council to provide bird netting. This was the most likely source of his infection, although it is uncertain whether his skin involvement was primary, secondary or both, due to ongoing pigeon exposure. A 54-year-old female patient under our care who had previously presented 3 months post-transplant with extensive noduloulcerative umbilicated lesions confirmed on biopsy to be primary cutaneous cryptococcosis also had close contact with pigeons and their droppings in the immediate post-transplant period. The incidence of cryptococcosis in immunocompromised patients is increasing and cutaneous involvement may be the first manifestation of disseminated disease. The clinical spectrum of skin lesions is highly polymorphic, making diagnosis challenging. However, it should be considered in immunocompromised patients presenting with atypical skin lesions, particularly in the early post-transplant period.

Primary Cutaneous Cryptococcosis Presenting Ulcers

Primary Cutaneous Cryptococcosis Presenting Ulcers

Primary Cutaneous Cryptococcosis of Nose With Extensive Tissue Destruction: A Rare Case Report.

Primary Cutaneous Cryptococcosis of Nose With Extensive Tissue Destruction: A Rare Case Report.

Primary Cutaneous Cryptococcosis Caused by Cryptococcus gatti in an Elderly Patient

According to the spread of Cryptococcus sp., fungal infections can be classified as primary or secondary. In primary cutaneous cryptococcosis, the fungi are restricted to the skin of the patients, without systemic involvement. The incidence of primary cutaneous cryptococcosis is high in patients with immunosuppression, and this type of infection is rarely observed in patients who are immunocompetent. In the present case report, a patient who is immunocompetent and has systemic comorbidity reported that, after skin trauma, ulcerovegetative lesions appeared in the right upper arm; the etiologic agent was identified as Cryptococcus gatti, serotype B. The cutaneous lesions healed completely after 5 months of fluconazole treatment.

Primary Cutaneous Cryptococcosis of Nasal Ala with Extensive Tissue Destruction

Abstract Introduction/Objective Primary cutaneous cryptococcosis (PCC) is rare and shows skin lesion(s) confined to a circumscribed body region mostly in immunocompromised host, with no sign of simultaneous dissemination condition. PCC usually presents as non-specific skin lesions such as cellulitis, nodules, and ulcers, and can be misdiagnosed in biopsy. We present a case of PCC with extensive tissue destruction. Methods/Case Report A 43-year-old male, with a history of human immunodeficiency virus infection 17 years ago, presented with complaint of his nose slowly “being eaten away” over the past 5 years after a bike accident. Physical examination showed most of the left nasal ala was completely destroyed, with visualizable septum. The biopsy of the left nasal ala showed the dermis has numerous yeasts with marked variation in size and shape, in foamy stroma with little inflammation. The capsules of the yeasts were highlighted by Mucicarmine stain. Grocott methenamine silver stain showed budding yeasts. The diagnosis of cutaneous cryptococcosis, gelatinous type, was rendered. Primary cutaneous cryptococcosis was considered based on no disseminated disease found, positive serum cryptococcus antigen with low titer (1:20), the culture of the nasal lesion positive for Crptococcus Neoformans, and the history of skin injury. The patient received appropriate treatment for PCC subsequently. Results (if a Case Study enter NA) NA Conclusion We have demonstrated a very rare case of undiagnosed/untreated PCC causing extensive destruction of skin and underlying nasal tissue. Identification of the histological features of cutaneous cryptococcosis, shown in this case, is the key for making the correct diagnosis.

Primary Cutaneous Cryptococcosis: A Rare Masquerading Presentation of Cryptococcus Infection

The yeast, Cryptococcus is widely present in the environment. Its main portal of entry is the respiratory tract. Clinical and experimental evidences indicate that cryptococcosis is usually a reactivation of a dormant infection. They have been recovered from soil contaminated with avian excreta, especially pigeon droppings and from decaying wood, fruits, vegetables and dust. Cryptococcusmay be found on skin of healthy subjects without causing any manifestation but it is known to cause life threatening infection in immunocompromised hosts. Primary Cutaneous Cryptococcosis (PCC) is an uncommon condition which is characterised by localised cryptococcal skin eruptions without dissemination to internal organs. Clinicians are aware of the typical presentation of cryptococcal infections occurring mostly in immunocompromised patients. Rare manifestations like PCC may go unnoticed leading to prolonged morbidity and health care cost. The present article is a case report of PCC in a 39-year-old immunocompetent male who presented with two months history of scattered erythematous indurated papules and plaques on his right foot, arm and abdominal region developed after having suffered minor injury at the cement factory. The patient was started on fluconazole to which he responded well.

15672 A cutaneous crypt for cryptococcosis: The skin as a marker for disseminated disease

Cutaneous cryptococcosis is caused by Cryptococcus neoformans, an opportunistic, encapsulated yeast that can cause significant morbidity and mortality. Cutaneous cryptococcosis can affect both immunocompromised and immunocompetent individuals, and can result from direct inoculation or hematogenous spread to skin. In primary cutaneous cryptococcosis, localized infection is subsequent to direct inoculation. In contrast, the more common, secondary skin involvement is due to hematogenous dissemination, which can be accompanied by spread to other organs such as the lungs and central nervous system. Here, we present a case of a 66-year-old man with a history of deceased-donor renal transplant secondary to polycystic kidney disease on chronic immunosuppression. He presented with a 2-month history of an enlarging, deep tender ulceration with heaped up borders and yellow purulent crust on the left eyelid. HSV and VZV PCR, bacterial culture and blood culture were negative. Lumbar puncture results were consistent with cryptococcal meningitis. Similarly, a biopsy of the periphery of the lesion demonstrated granulomatous and suppurative inflammation and refractile yeast forms, findings compatible with cryptococcosis. Gomori methenamine silver stain highlighted many fungi and mucicarmine stain highlighted their capsules. The patient was treated with intravenous amphotericin B and flucytosine for disseminated cryptococcal infection with cutaneous involvement. In immunocompromised patients, the diagnosis can be challenging, as cutaneous findings are nonspecific and can often mimic other conditions. Cutaneous involvement can serve as a helpful clue of underlying disseminated disease, and dermatologists play a crucial role in the diagnosis and early treatment of this opportunistic, often life threatening disease.

Pathological and molecular detection of a rare case of cutaneous cryptococcosis in a 9-year-old horse

This report describes a rare case of primary cutaneous cryptococcosis in equines. A young gelding horse was presented with facial masses showing ulcerations and yellowish discharge. Histopathological examination of biopsy specimens showed a dermal granulomatous reaction containing neutrophils, macrophages, and giant cells. In addition, numerous spherical yeast-like organisms were clearly observed within the granulomatous reaction. We suspected that the observed organisms belong to the Cryptococcus spp., which was indeed by its shape on Sabouraud dextrose agar, Gram-stained smear suggestive C. neoformans, and confirmed on PCR. Our report is one of the worldwide rare reports linking cryptococcosis to cutaneous granuloma in equines and the first to provide a molecular confirmation of the cryptococcal involvement. The report highlights the importance of considering cryptococcosis in differential diagnosis of infectious cutaneous masses in equines.

Pyoderma gangrenosum and primary cutaneous cryptococcosis in an ulcerative colitis patient

Pyoderma gangrenosum and primary cutaneous cryptococcosis in an ulcerative colitis patient

Primary Cutaneous Cryptococcosis in an Immunocompetent 6-Year-Old Female

A 6-year-old otherwise healthy female presented to the ED with a right eyebrow lesion for one month.  Previous I&D attempts and empiric antibiotic treatment had failed to improve the lesion.  Following dermatology referral, superficial culture resulted with growth of Cryptococcus neoformans after which completion of oral fluconazole treatment resolved the lesion.  Though Cryptococcus neoformans infections commonly plague immunocompromised patients, primary cutaneous cryptococcosis in the immunocompetent patient is a rare but documented infection with a paucity of reported pediatric cases, and frontline physicians should be aware of such a diagnosis in the setting of persistent skin lesions without response to more commonly utilized therapies.

A CASE REPORT OF SECONDARY CUTANEOUS CRYPTOCOCCOSIS IN A RETROVIRUS POSITIVE PATIENT

Cryptococcosis is a systemic mycosis caused by the capsulated yeast Cryptococcus neoformans. Cryptococcus remains an important opportunistic pathogen in HIV positive patients. It is usually acquired through inhalation of spores and by invasion of the respiratory system, and then, the organisms may spread hematogenously to other viscera mainly central nervous system. Although there are some reports of primary cutaneous cryptococcosis, cryptococcal skin disease is a rare feature of disseminated cryptococcosis and has poor outcome if undiagnosed and untreated. We present a case of secondary cutaneous cryptococcosis in a 50-year-old male, who was diagnosed as a case of retroviral disease 3 years back but not on anti-retroviral therapy.

Cryptococcal Cellulitis in a Diabetic with Nephropathy on Adalimumab Therapy for Rheumatoid Arthritis

Cutaneous infection with Cryptococcus neoformans is rare but can occur in the setting of rheumatoid arthritis due to immunosuppression. Risk factors include chronic kidney disease and use of tumor necrosis factor-alpha (TNF-α) inhibitor adalimumab. We report the fourth case of primary cutaneous cryptococcosis (PCC) in a diabetic female more than 60 years old living in rural Northwest Tennessee and taking adalimumab for rheumatoid arthritis. In a literature review of existing cases, this is the second case involving simultaneous chronic kidney disease and the first case in a diabetic and following extended TNF-α inhibitor immunosuppression monotherapy. Physicians should consider cryptococcal infection in a patient who develops cellulitis that is unresponsive to empiric therapy. In addition, it is imperative to monitor rheumatoid arthritis patients taking adalimumab closely and consider alternative agents in those with pre-existing immunosuppression or known risk factors for opportunistic infections as primary prevention.

Complete Remission of Primary Cutaneous Cryptococcosis in an Immunosuppressed Patient after Fluconazole Treatment

Cryptococcus neoformans is opportunistic encapsulated yeast that represents the most frequent cryptococcal species found in humans. It can cause three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and cutaneous cryptococcosis. Cutaneous cryptococcosis may represent the dissemination of a systemic infection (especially from nervous or pulmonary primary site of infection) or may be the only localization, due to a direct inoculation into the skin, because of a traumatic injury. Primary cutaneous cryptococcosis (PCC) is rare and mainly affects elderly patients, from rural areas, with history of cutaneous injuries and activities predisposing wounds or exposure to bird droppings. Immunosuppression may be a predisponing factor. The most utilized treatment is fluconazole, but often, especially for ulcers or deep wounds; surgery is required for complete tissues repair. Herein, we present a case of PCC in an immunosuppressed patient, with destroying ulcers involving deep tissues, completely resolved after fluconazole treatment, without surgical intervention.

Primary Cutaneous Cryptococcosis: A New Case of This Rare Entity.

Primary Cutaneous Cryptococcosis: A New Case of This Rare Entity.

Multilocus sequence typing analysis reveals that Cryptococcus neoformans var. neoformans is a recombinant population

Cryptococcus neoformans var. neoformans (serotype D) represents about 30% of the clinical isolates in Europe and is present less frequently in the other continents. It is the prevalent etiological agent in primary cutaneous cryptococcosis as well as in cryptococcal skin lesions of disseminated cryptococcosis. Very little is known about the genotypic diversity of this Cryptococcus subtype. The aim of this study was to investigate the genotypic diversity among a set of clinical and environmental C. neoformans var. neoformans isolates and to evaluate the relationship between genotypes, geographical origin and clinical manifestations. A total of 83 globally collected C. neoformans var. neoformans isolates from Italy, Germany, France, Belgium, Denmark, Greece, Turkey, Thailand, Japan, Colombia, and the USA, recovered from different sources (primary and secondary cutaneous cryptococcosis, disseminated cryptococcosis, the environment, and animals), were included in the study. All isolates were confirmed to belong to genotype VNIV by molecular typing and they were further investigated by MLST analysis. Maximum likelihood phylogenetic as well as network analysis strongly suggested the existence of a recombinant rather than a clonal population structure. Geographical origin and source of isolation were not correlated with a specific MLST genotype. The comparison with a set of outgroup C. neoformans var. grubii isolates provided clear evidence that the two varieties have different population structures.

Fatal Primary Cutaneous Cryptococcosis

Introduction Cryptococcus is a type of opportunistic encapsulated yeast with a worldwide distribution [1]. Cryptococcosis continues to cause significant morbidity and mortality, especially in immunocompromised patients such as those with AIDS, organ transplants, haematological malignancies, and corticosteroid treatment [2]. Primary cutaneous cryptococcosis (PCC), lesions associated with a skin portal of entry without systemic infection, is rare but life threatening [3]. Here, we report one case of rare fatal PCC in an immunosuppressed patient. The clinical diagnosis corroborated histological findings and causative agent was confirmed as Cryptococcus neoformans in culture isolate. Case Blog A 23-year-old man was admitted to our hospital with fever and swelling, painful lesions in both the anterior and the posterior of his trunk, with no history of cough, headache or vomiting. He received a massage half a month prior to admission. In his 20-month history of nephrotic syndrome, the patient was diagnosed with IgA nephropathy by renal biopsy and treated with prednisone (30-60 mg/d) for more than 1 year. Leflunomide and cyclophosphamide were each added once for a brief period. He had no known history of human immunodeficiency virus (HIV) infection and reported no contact with doves, poultry or other types of animals. On physical examinations, the patient had erythema, tenderness, edema and soft swelling skin lesions around the trunk. Cutaneous ulcers developed with time, with necrotic subcutaneous soft tissue and perilesional edema. The laboratory examination showed that peripheral white blood cell, CD4+ T cell count, CD8+ T cell count, CD20+ B cell count and the CD4+/CD8+ T cell ratio were 23.9(3.5-9.5) × 109/L, 143(651.3 ± 273.6)/μl, 236(452.62 ± 210.83)/μl, 159(125.22 ± 51.55)/ ul and 0.6, respectively, and that total blood immunoglobulin and immunoglobulin G were 17.9 (20-30) g/l and 4.8(7-16) g/l, respectively. The serum creatinine level was elevated at 1.86 mg/dl, and the cystatin C level increased to 2.50 mg/dl. Antibodies to HIV and to hepatitis B and C were all negative, and blood cultures were negative. The serum cryptococcal antigen latex agglutination test (Immuno-Mycologics, Inc., Norman, OK, USA) was positive at a titer of 1: 32. Chest computed tomography (CT) scan on Hospital Day 1 revealed signs of mild pulmonary infection without nodules. A cultural examination of necrotizing tissue on Sabourad glucose agar at 37°C for 3 days yielded cream-like colonies. The isolate was identified as C. neoformans by API 20C AUX (Biomerieux, Marcy, France). The antifungal susceptibility test showed that the fungus was sensitive to itraconazole but resistent to fluconazole. Skin biopsy revealed chronic inflammation with necrosis and numerous variably sized, round-to-oval budding organisms. Periodic acid-Schiff (PAS) staining of the dermis and soft tissue revealed blue, positive capsulated organisms (Figure 1) that were consistent with Cryptococcus. Cerebrospinal fluid examination, brain magnetic resonance imaging and abdominal ultrasound examination did not show any abnormaity. Fungal culture of the soft tissue revealed the growth of Cryptococcus and confirmed our clinical diagnosis of PCC. The patient was started on fluconazole (600 mg/d for 4 days) intravenously and then changed to itraconazole (500 mg/d for 5 days) intravenously according to the result of antifungal sensitivity test. Surgical debridement was performed every day (Figure 2). There was no evidence of disseminated intravascular coagulation. However, on the twenty-second day since admission, the patient died following continuous capillary haemorrhage

Primary Cutaneous mycosis in an Immunocompetent Parrot Keeper Due to Cryptococcus neoformans

The prime objective of this paper is to delineate the etiologic significance of Cryptococcus neoformans in primary cutaneous mycosis of a 34- year- old male immunocompetent person, who was occupationally exposed to the excreta of a caged parrot. The biopsy obtained from the cutaneous lesion of a parrot keeper was examined in Indian ink mount, and was cultured onto the plates of Pal’s sunflower seed medium. In addition, the urine and blood of patient was also inoculated on Pal’s sunflower seed medium to rule out the systemic infection. In order to establish the source of infection, samples of parrot droppings, and wooden box were examined on Pal’s sunflower seed medium. Microscopic examination of clinical specimen in India ink preparation revealed circular, wide, thickly encapsulated yeast cells of Cryptococcus neoformans . Numerous dark brown colored colonies of C. neoformans grew from biopsied tissue on Pal’s sunflower seed medium. The microscopic morphology of the fungal isolates was done in Narayan stain. There was no growth of C. neoformans from blood, and urine of the patient on Pal’s sunflower seed medium. The pathogen was easily recovered from the parrot droppings, and wooden box on Pal’s sunflower medium. These findings conclusively established that the patient acquired primary cutaneous cryptococcosis from his immediate environment as revealed by the presence of C. neoformans in the excreta, and wooden cage of the caged parrot.