CASE REPORT
Cutaneous cryptococcosis in HIV patient: a diagnostic dilemma
 
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Submission date: 2017-04-20
 
 
Final revision date: 2017-11-07
 
 
Acceptance date: 2018-01-11
 
 
Publication date: 2018-05-21
 
 
HIV & AIDS Review 2018;17(2):142-145
 
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ABSTRACT
Cutaneous cryptococcosis is an opportunistic infection commonly found in patients with immunosuppression, especially HIV/AIDS, hematological malignancy such as leukemia and lymphoma, diabetes mellitus, sarcoidosis, cancer chemotherapy, and solid organ transplant. The disease has also been occasionally reported in immunocompetent individuals. Although the burden of HIV/AIDS is high in Nigeria, cutaneous cryptococcosis is rarely found. It is caused by ubiquitous encapsulated basidiomycetes yeast-like fungi Cryptococcus neoformans and C. gattii. These two distinct species consist of five serotypes A, D, and AD as seen in C. neoformans, and serotype B and C are found with C. gattii. The emergence of cutaneous cryptococcosis can provide a window of opportunity for early clinical diagnosis and treatment of more devastating disease such as cryptococcal meningitis with its high mortality of 70-80%. So, physician should be aware of cutaneous cryptococcosis mimicking other cutaneous diseases like Kaposi sarcoma, molluscum contagiosum to help in early diagnosis and treatment. We report a rare case of female HIV patient with cutaneous cryptococcosis of the face, misdiagnosed as Kaposi sarcoma, and adverse drug reaction. At the time of this report, there was no evidence of any systemic disease. She was successfully treated with oral fluconazole monotherapy and to continue life-long oral fluconazole therapy. Patient is to be followed-up with regular physical examinations for any possible recurrence. Physicians should be well informed about many forms of clinical presentations and treatments of cutaneous cryptococcosis to reduce the burden of the disease especially in HIV/AIDS.
REFERENCES (20)
1.
Sanchez P, Bosch RJ, de Galvez MV, et al. Cutaneous cryptococcosis in two patients with acquired immunodeficiency syndrome. Int J STD AIDS 2000; 11: 477-480.
 
2.
Park BJ, Wannemuehler KA, Marston BJ, et al. Estimation of  the current global burden of  cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009; 23: 525-530.
 
3.
Neuville S, Dromer F, Morin O, et al. Primary cutaneous cryptococcosis: a  distinct clinical entity. Clin Infect Dis 2003; 36: 337-347.
 
4.
Ellis DH, Pfeiffer TJ. Natural habitat of  Cryptococcus neoformans var. gattii. J Clin Microbiol 1990; 28: 1642-1644.
 
5.
Sing Y, Ramdial PK. Cryptococcal inflammatory pseudotumours. Am J Surg Pathol 2007; 31: 1521-1527.
 
6.
Freij JB, Freij BJ. The  Earliest Account of  Human Cryptococcosis (Busse-Buschke Disease) in a  Woman with Chronic Osteomyelitis of  the  Tibia. Pediatr Infect Dis J 2015; 34: 1278.
 
7.
Busse O. Ueber parasitare zelleninschlusse und ihre zuchtung. Zentralbl Bakterial 1894; 16: 175-180.
 
8.
Buschke A. Ueber eine durch Coccidien Hervergerufene Krankheit des menschen. Deutsche Med Wochenschr 1895; 2: 14.
 
9.
Leão CA, Ferreira-Paim K, Andrade-Silva L, et al. Primary cutaneous cryptococcosis caused by Cryptococcus Gattii in an  immunocompetent host. Med Mycol 2011; 49: 352-355.
 
10.
Pau M, Lallai C, Aste N, et al. Primary cutaneous cryptococcosis in an  immunocompetent host. Mycoses 2010; 53: 256-258.
 
11.
John CC, William E, David A. Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol 2003; 41: 177-188.
 
12.
Doering TL. How sweet it is! Cell wall biogenesis and polysaccharide capsule formation in Cryptococcus neoformans. Annu Rev Microbiol 2009; 63: 223-247.
 
13.
Fonseca A, Boekhout T, Fell JW. Cryptococcus Vuillemin (1901). In: The  Yeasts: a  Taxonomic Sudy. Vol. 3. CP Kurtzman, JW Fell, T Boekhout (eds.). Elsevier, Amsterdam 2011; pp. 1661-1745.
 
14.
Srikanka D, Santiago-Tirado FH, Doering TL. Cryptococcal neoformans: Historical curiosity to modern pathogen. Yeast 2014; 31: 47-60.
 
15.
Alp S. Melanin and its role on the  virulence of  Cryptococcus neoformans. Mikrobiyol Bul 2010; 44: 519-526.
 
16.
Wong B, Perfect JR, Beggs S, Wright KA. Production of  the  hexitol D-mannitol by Cryptococcus neoformans in-vitro and in rabbits with experimental meningitis. Infect Immun 1990; 58: 1664-1670.
 
17.
Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am 2006; 20: 507-544.
 
18.
Garcia-Hermoso D, Janbon G, Dromer F. Epidemiological evidence for dormant Cryptococcus neoformans infection. J Clin Microbiol 1999; 37: 3204-3209.
 
19.
Neuville S, Dromer F, Morin O, et al.; French Cryptococcosis Study Group. Primary Cutaneous Cryptococcosis: A  Distinct Clinical Entity. Clin Infect Dis 2003; 36: 337-347.
 
20.
Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the  management of  cryptococcal disease: 2010 update by the  infectious diseases society of  America. Clin Infect Dis 2010; 50: 291-322.
 
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ISSN:1730-1270
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