Primary cutaneous cryptococcal infection with subsequent erythema nodosum in a 10-year-old immunocompetent girl

Hyde, Kimberly; Warren, Donald W.; Gavino, Alde Carlo P.

doi:10.1016/j.jdcr.2016.09.001

Cited by 3 publications

(5 citation statements)

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“…In the year 1972, Noble and Fajardo [ 10 ] proposed three diagnostic criteria for PCC (Table 1 ). We recorded the features of both our case and the 21 additional cases of PCC in immunocompetent patients due to C. neoformans in the last 20 years [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. We excluded cases of PCC due to C. gattii , which is well known to be a cause of infection of immunocompetent patients in endemic areas [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Cutaneous Cryptococcosis due to Cryptococcus neoformans in an Immunocompetent Host Treated with Itraconazole and Drainage: Case Report and Review of the Literature

et al. 2021

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Cryptococcus neoformans is an opportunistic germ, usually causing infections in immunocompromised patients. The main sources of infection with C. neoformans are excrement from birds, decomposing wood, fruit, and vegetables. Primary cutaneous cryptococcosis (PCC) is a clinical entity, differing from secondary cutaneous cryptococcosis and systematic infection. We report the case of an immunocompetent 60-year-old woman with PCC due to C. neoformans in her right thumb. She reported an accidental injury caused by a rose thorn while she was gardening. Clinical examination showed the presence of an erythematous ulcerated nodule with elevated borders, suppuration, and central necrosis. Skin histology examination showed cutaneous and subcutaneous fibrinoid necrosis with bleeding, abscess, neutrophil-rich cellular infiltration, and the presence of PAS-, Grocott- and mucin-positive spores. The mycological culture showed milky and creamy colonies of C. neoformans after 3 days. As there was no previous history of pulmonary cryptococcosis, we diagnosed PPC. We treated the patient surgically with accurate debridement of nonvital tissues in the right thumb. In addition, we started itraconazole treatment 100 mg twice daily for 6 months, which led to rapid clinical improvement without relapse. PCC is a rare infection that can present with quite unspecific clinical pictures including acneiform lesions, purpura, vesicles, nodules, abscesses, ulcers, granulomas, pustules, draining sinuses, and cellulitis. Prolonged systemic antifungal therapy is necessary in order to get a healing result without relapse. We summarize all the cases of PCC in immunocompetent patients published so far in the literature.

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Section: Discussionmentioning

confidence: 99%

Primary Cutaneous Cryptococcosis due to Cryptococcus neoformans in an Immunocompetent Host Treated with Itraconazole and Drainage: Case Report and Review of the Literature

et al. 2021

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“…

Cryptococcosis is a fungal infection caused by Cryptococcus species, most commonly in immunocompromised individuals, especially in patients with HIV, organ transplant, and cancer chemotherapy. [1][2][3][4] The infection is relatively uncommon in immunocompetent patients in the absence of immunosuppression. Thus, cryptococcosis might be overlooked in immunocompetent individuals, which can lead to delayed diagnosis and treatment, and in some cases, fatal outcome.

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confidence: 99%

Primary Cutaneous Cryptococcosis Caused by Cryptococcus Neoformans in an Immunocompetent Patient

Marushchak,

Meehan,

Wee

2023

J of Skin

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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.

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“…Treatment options for immunocompetent patients range from a clinical observation to an antimycotic therapy, or to a surgical debridement. In PCC cases, the Infectious Disease Society of America guidelines recommended fluconazole 400 mg, orally, every day, for 6–12 months (Perfect et al, ), but therapeutic regimens are different, according to the situation (Hyde et al, ; Park et al, ; Posada et al, ).…”

mentioning

confidence: 99%

“…To the best of our knowledge, in the literature, there are less than 40 PCC cases about immunocompetent patients (Hyde et al, ). In our case, we observed clinical healing after 4 weeks of antifungal therapy, and we suppose that a healthy immune system could help the resolution of limited PCC infections, such as those reported by other authors (Du et al, ; Hyde et al, ).…”

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confidence: 99%

“…Skin involvement is typically characterized by various, nonspecific presentations (e.g., papules, pustules, nodules, abscesses, edema, panniculitis, and ulcers) and can be due to a primary infection or due to a secondary systemic hematogenous spread. Skin manifestations are typically localized in body areas not covered by clothes (Arjona-Aguilera, Jiménez-Gallo, Collantes-Rodríguez, & Linares-Barrios, 2017;Hayashida, Seque, Pasin, Enokihara, & Porro, 2017;Hyde, Warren, & Gavino, 2016;Kikuchi et al, 2016). The sporotrichoid pattern is rare (Posada, De la Torre, Gonzalez-Sixto, & Cruces, 2009;Tobin & Jih, 2001).…”

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confidence: 99%

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An unusual presentation of primary cutaneous cryptococcosis

Longhitano

Peccerillo

Odorici

et al. 2019

Dermatologic Therapy

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Primary cutaneous cryptococcal infection with subsequent erythema nodosum in a 10-year-old immunocompetent girl

Cited by 3 publications

References 5 publications

Primary Cutaneous Cryptococcosis due to <b><i>Cryptococcus neoformans</i></b> in an Immunocompetent Host Treated with Itraconazole and Drainage: Case Report and Review of the Literature

Primary Cutaneous Cryptococcosis due to <b><i>Cryptococcus neoformans</i></b> in an Immunocompetent Host Treated with Itraconazole and Drainage: Case Report and Review of the Literature

Primary Cutaneous Cryptococcosis Caused by Cryptococcus Neoformans in an Immunocompetent Patient

An unusual presentation of primary cutaneous cryptococcosis

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