Cutaneous Cryptococcosis in a Patient with Cirrhosis and Hepatitis C Virus Infection

Miyamae, Takako; Kawakami, Yoshio; Otsuka, Mikio; Hachiya, Masahiro; Yamanoi, Takahiro; Ohashi, Kenichi; Suzutani, Tatsuo; Yamamoto, Toshiyuki

doi:10.2340/00015555-0779

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Cirrhotic patients have been shown to have an increased frequency of immunodeficiency-associated infections, one in particular being C. neoformans , which was seen in the presented patient, as well as several other cases in the past few years (1, 8, 10–15). It can present as cryptococcemia, cryptococcal meningitis, disseminated cryptococcosis, cryptococcal pneumonia, or even cryptococcal peritonitis.…”

Section: Discussionmentioning

confidence: 54%

Cryptococcemia in an HIV-negative patient with decompensated liver cirrhosis

Kandula

Kelkar

Liberio

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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BackgroundCryptococcal infections have been mostly associated with immunocompromised individuals, 80–90% of whom have been HIV-positive patients. Increasingly, cryptococcal infections are being reported in cirrhotic patients who are HIV-negative. The underlying immunologic defects in cirrhotic patients seem to play an important role in predisposing them to cryptococcosis and affecting their morbidity and mortality.Case presentationWe present a case of disseminated cryptococcosis in an HIV-negative patient with underlying cirrhosis, who had rapid worsening of his hyponatremia with renal failure and was unable to recover, despite aggressive measures.ConclusionCryptococcus is a more common culprit of infections seen in cirrhotic patients than what it was previously known, and a high index of suspicion is required to diagnose these patients. Identification of poor prognostic factors, early diagnosis and intervention is crucial in the management of these patients.

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Section: Discussionmentioning

confidence: 54%

Cryptococcemia in an HIV-negative patient with decompensated liver cirrhosis

Kandula

Kelkar

Liberio

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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“…One other case of hepatitis C-related skin infection with Cryptococcus neoformans has been described. 11 This case demonstrates the challenges treating patients with cirrhosis because of significant comorbidities and resultant medication adverse effects.…”

Section: Discussionmentioning

confidence: 95%

Unusual Cause of Cellulitis in a Patient with Hepatitis C and Cirrhosis

Aruch

Bhusal

Hamill

2011

The American Journal of Medicine

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“…Cutaneous cryptococcosis is an opportunistic infection, and occasionally involves immunocompromised hosts, such as patients with HIV infection, hepatitis C virus infection, lymphomas, systemic lupus erythematosus, and transplant recipients receiving immunosuppressive therapies (3)(4)(5)(6)(7). Case 1, who had been suffering from erythroderma, and was immunosuppressed with systemic prednisolone therapy.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Cryptococcosis Mimicking Pyoderma Gangrenosum: A Report of Four Cases

Kikuchi¹,

Hiraiwa²,

Ishikawa³

et al. 2016

Acta Derm Venerol

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SHORT COMMUNICATIONCryptococcosis is a fungal infection caused by Cryptococcus neoformans, and frequently presents with meningitis, pneumonia, and cutaneous eruptions in immunocompromised patients. Clinical features of cutaneous cryptococcosis vary; thus, it is necessary to suspect the disease and perform a skin biopsy in order to make an early and accurate diagnosis. We herein report 4 cases of cutaneous cryptococcosis presenting with pyoderma gangrenosum-like appearance. CASE REPORTCase 1. An 85-year-old woman was admitted to hospital, complaining of fever, as well as ulcers on the face, neck, and upper extremities. She had been suffering from erythroderma and was treated with prednisolone (20 mg/day) for the previous year. Physical examination revealed deep irregular ulcers with necrosis on the upper extremities ( Fig. 1a) and nodular lesions with crusts on the neck. In addition, erythema and hemorrhagic blisters were found on the left lower leg. Laboratory examination showed leukocytosis (10,400/μl), elevated C-reactive protein (CRP) (4.21 mg/dl) and β-D-glucan (56.1 pg/dl: normal 0-11) levels, and positive C. neoformans antigen. Histological examination revealed granulomatous inflammation infiltrated with lymphocytes and histiocytes, and degeneration of the dermis and subcutaneous fat tissues. Numerous rounded fungal bodies positively stained by PAS and Grocott were found in the subcutaneous fat tissue. Microbiological culture from ulcer exudate showed C. neoformans. Examination by computed tomography (CT) revealed pneumonia, and a cerebral abscess was detected by magnetic resonance imaging (MRI). The ulcers healed after intravenous administration of fluconazole (200 mg/ day), however the patient died of sepsis.Case 2. A 74-year-old woman presented with an ulcer on the right lower leg that had appeared 6 months previously. She had been treated at an internal medicine clinic, but the ulcer deteriorated. She was also suffering from diabetes mellitus, chronic kidney disease and bronchial asthma. Physical examination revealed irregular ulcers with necrosis on the right lower leg (Fig. 1b). Laboratory examination showed a normal white blood cell count (7,500/μl), elevated CRP (0.97 mg/dl) and β-D-glucan (12.4 pg/dl) levels, and positive C. neoformans antigen. Histological examination revealed inflammatory infiltrates of lymphocytes and histiocytes in the dermis, and a number of fungal bodies stained with PAS, Grocott, and mucicarmine were found in the dermis (Fig. 2). Culture from ulcer exudates as well as blood verified C. neoformans. Chest CT revealed pneumonia, and two weeks after administration, she died of respiratory failure. Case 3. A 93-year-old woman was hospitalized, complaining of redness and swelling of the thighs for the previous month. She had been treated without response with antimicrobial drugs. Physical examination revealed irregular deep ulcers with necrosis on the right thigh (Fig. 1c). Laboratory examination showed leukocytosis (11,680/μl), elevated CRP (4.24 mg/dl) level, normal β-D-glucan (...

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Cutaneous Cryptococcosis in a Patient with Cirrhosis and Hepatitis C Virus Infection

Cited by 6 publications

References 7 publications

Cryptococcemia in an HIV-negative patient with decompensated liver cirrhosis

Cryptococcemia in an HIV-negative patient with decompensated liver cirrhosis

Unusual Cause of Cellulitis in a Patient with Hepatitis C and Cirrhosis

Cutaneous Cryptococcosis Mimicking Pyoderma Gangrenosum: A Report of Four Cases

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