cutaneous cryptococcosis

Skin lesions of cutaneous cryptococcosis may be the first evidence of an occult systemic infection.

Although many cases have been reported as instances of primary cutaneous cryptococcosis, probably only a few of these have resulted from primary inoculation of organisms into the skin, thereby fulfilling the criteria of a true primary cutaneous infection.

Preceding trauma has sometimes been implicated in primary cutaneous disease.

Most patients are immunocompromised, and the infection is now a well-recognized occurrence in patients with AIDS.

With improving antiretroviral therapy for patients with AIDS, organ transplant recipients are now at the highest risk of acquiring cryptococcosis. The risk in transplant recipients is 2.6–2.8%. The new immune modulator drugs have recently been associated with localized and disseminated disease.

The cutaneous presentations of cryptococcosis are protean and include papulonodules, ulcers, pustules, plaques, ecchymoses, and cellulitis.

Lesions may rarely simulate pyoderma gangrenosum, herpes, keloids, or molluscum contagiosum.

Any site may be involved, but there is a predilection for the face, neck, and forearms.

Concurrent infection with alternariosis has been reported. In another case, leprosy was the associated infection.

A rapid diagnosis may be made by examination of India-ink preparations of aspirates or Tzanck smears.

The organisms are readily isolated on Sabouraud’s agar. Rarely, other species of Cryptococcus have been isolated from infected tissues.