Korean J Clin Microbiol.  2012 Jun;15(2):70-73. 10.5145/KJCM.2012.15.2.70.

Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing's Syndrome: A Case Report and Review of the Literature

• Ko YJ
• Hong MH
• Park CM
• Moon HW
• Hur M
• Yun YM

• KMID: 1434176
• DOI: http://doi.org/10.5145/KJCM.2012.15.2.70

Abstract

Cryptococcus neoformans (C. neoformans) is a ubiquitous yeast-like fungus that has been a common opportunistic human pathogen, especially in immunocompromised patients. Although skin lesions due to C. neoformans are found in 10-15% of patients with systemic cryptococcosis, primary cutaneous cryptococcosis without systemic infection is rare and now considered a distinct clinical entity. We report a case of primary cutaneous cryptococcosis in a patient with iatrogenic Cushing's syndrome. A 73-year-old woman presented with pain and discharge from lesions on her left forearm. The patient had been treated with oral corticosteroids for 20 years, and as a result had developed iatrogenic Cushing's syndrome. A skin fragment of the ulcer was cultured, and the encapsulated fungus were isolated and identified as C. neoformans using a Vitek2 system (Vitek2 ID-YST, bio Merieux, France) and API 20C (bioMerieux). Concurrent blood and urine cultures were negative for growth. At first, she was treated with antibiotics due to suspicion of cellulitis. After surgical resection and treatment with systemic and oral fluconazole, her wound was improved with scar. Primary cutaneous cryptococcosis should be considered when skin lesions are not responsive to antibiotics and accurate identification is important for proper treatment.

Keyword

Cryptococcus neoformans; Cushing's syndrome; Primary cutaneous cryptococcosis

MeSH Terms

Adrenal Cortex Hormones
Aged
Anti-Bacterial Agents
Cellulitis
Cicatrix
Cryptococcosis
Cryptococcus neoformans
Cushing Syndrome
Female
Fluconazole
Forearm
Fungi
Humans
Immunocompromised Host
Skin
Ulcer
Adrenal Cortex Hormones
Anti-Bacterial Agents
Fluconazole

Figure

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  Fig. 1 Skin lesion due to C. neoformans on the patient's left forearm before (A) and after (B) debridement and antifungal treatment for 10 days.

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  Fig. 2 Mucoid and creamy colonies of C. neoformans on Sabouraud dextrose agar (A). Photomicrograph of an India ink preparation (B), and Gram staining (C), illustrating the irregular-sized, encapsulated, spherical yeast cells of C. neoformans (×1,000). After subculture, capsules became thinner than initial preparation in India ink stain.

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