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Unusual case of primary cutaneous cryptococcosis We report the case of a 26-year-old male who presented to his general practitioner with a painful swelling in the right posterior deltoid region. The lesion had slowly grown over a period of 2 years. He was fit and well, took no regular medications and had never smoked. He had previously worked as an air-conditioner technician. Fine needle aspirate was suspicious for fungal infection and was subsequently referred to an infectious diseases physician for work up. He remained systemically well throughout the course of investigations that followed. He was found to be leukopenic (white cell count 3.5 × 10 9 /L) with persistent neutropenia (neutrophils <2.0 × 10 9 /L); however, CD4+ lymphocyte count remained normal and serum cryptococcal antigen was positive for 6 months. Blood cultures remained negative as did cerebrospinal fluid (CSF) cultures and cryptococcal antigen. Imaging revealed no disease in the lungs or the central nervous system (CNS). Ultrasound demonstrated a heterogeneous echogenic lesion, which was well encapsulated and consistent with an abscess or granuloma (Fig. 1). Fluid sent for culture and histology showed fungal elements, with subsequent culture of the fungal pathogen, Cryptococcus gattii. He was commenced on oral antifungal therapy with fluconazole 400 mg twice daily. Referral was made to the plastic surgical service for consideration of surgical excision. It was felt that the size of the lesion would preclude effective antifungal penetration. He underwent marginal excision of the lesion with direct closure (Fig. 2). Histology confirmed a cryptococcoma excised with clear margins and perilesional tissue was culture negative (Fig. 2). He was followed up in outpatient department with a well-healed wound and discharged to the ongoing care of infectious diseases with systemic antifungal therapy.