Primary cryptococcal cellulitis caused by Cryptococcus neoformans var. gattii in an immunocompetent host

Abstract

Primary cutaneous cryptococcal infection is uncommon. The cutaneous manifestations are most often the result of dissemination from the central nervous system or lung, usually in an immunocompromised host; cellulitis is regarded as the rarest cutaneous form. Primary cutaneous cryptococcosis has occasionally been reported in the immunocompetent, the causative organism being Cryptococcus neoformans var. neoformans. We present a case of cellulitis of the right arm in a 75-year-old man caused by Cryptococcus neoformans var. gattii, a fungus which is endemic in Australia and an important cause of infection in the immunocompetent. This is the first case described of a primary cutaneous infection due to Cryptococcus neoformans var. gattii. The interesting ecology of this organism is discussed.

Cutaneous cryptococcosis in a diabetic renal transplant recipient

“…However, critical analysis of the literature in two recent reviews (Neuville et al, 2003;Christianson et al, 2003) suggests that cutaneous cryptococcosis can also occur as a primary disease both in immunocompetent and immunocompromised individuals, where skin serves as the primary portal of entry. This observation is noteworthy since the existence of PCC as a distinct clinical entity has been controversial, despite some well-documented case reports (Goonetilleke et al, 1995;Hamann et al, 1997;Handa et al, 1998). C. neoformans has been shown to cause almost every type of cutaneous lesion.…”

Cryptococcus gattii Infections

“…Primary cutaneous C. gattii infection has been reported for only a few patients, including patients from Australia and Brazil. It is typically preceded by traumatic inoculation and affects the scalp and limbs of immunocompetent patients (228,235,256,(287)(288)(289)(290). Lesions may be solitary or present as extensive ulceration or cellulitis.…”

Primary Cutaneous Cryptococcosis in an Immunocompetent Host: Case Report and Review of the Literature

“…PCC in the immunocompetent host has only been described in case reports [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]. Noble and Fajardo [27]established three criteria to consider a case as PCC: (1) absence of infection in any other viscera; (2) C. neoformans must be isolated from the skin; (3) absence of extracutaneous infection within 4 weeks after the PCC diagnosis.…”

“…We have only found 1 case of PCC caused by C. neoformans var. gattii [18]. Again, PCC usually affects immunosuppressed patients (e.g.…”

“…neoformans in his third right finger after an accidental puncture caused by a metallic object at his workplace. We have found another 16 cases of PCC in immunocompetent individuals in our literature review (Medline database) of the last 38 years [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]. …”