title: Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities.
abstract: BACKGROUND
  Cryptococcal necrotizing fasciitis that is localized to the lower extremities is very rare.
  
  
  OBJECTIVE
  We describe a case of a renal transplant recipient who presented with necrotizing fasciitis of the legs caused by Cryptococcus neoformans, a fungus that is rarely associated with this disease.
  
  
  METHODS
  This is a case report with literature review.
  
  
  RESULTS
  The patient was hospitalized, and the site of infection was debrided to the level of the periosteum. Cultures and histopathologic examination of biopsy material revealed an invasive deep-seated infection with a fungal organism that was consistent with C. neoformans. After 21 days on parenteral amphotericin B (Ambisome; Er-Kim Pharmaceuticals) treatment, the patient was switched to oral itraconazole (Itraspor; Janssen-Cilag Pharmaceuticals) 200 mg/day. He was discharged after 30 days of hospitalization with his wounds completely healed. He continued on oral fluconazole for a total course of 6 weeks.
  
  
  CONCLUSIONS
  Systemic fungal infections continue to be an important cause of morbidity and mortality in transplant recipients. The insidious nature and atypical manifestations of these infections often delay diagnosis and therapy. In immunosuppressed patients, persistent fever that does not respond to antibacterial therapy should alert the physician to the possibility of fungal infection.
authors.affiliation: Department of General Surgery, Baskent University Faculty of Medicine, Sokak no. 45, Bahçelievler, 06490 Ankara, Turkey.
authors.forename: Ozgür
authors.initials: O
authors.lastname: Başaran
authors.forename: Remzi
authors.initials: R
authors.lastname: Emiroğlu
authors.forename: Unser
authors.initials: U
authors.lastname: Arikan
authors.forename: Hamdi
authors.initials: H
authors.lastname: Karakayali
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003453:Cryptococcosis / Q000150:complications / Q000628:therapy*; D003646:Debridement / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D016030:Kidney Transplantation; D007866:Leg; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D000666:Amphotericin B