Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report.
BACKGROUND
Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis.


METHODS
An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA). Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed.


CONCLUSIONS
Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients.
Probst
Corina
C
Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. corina.probst@klinik.uni-regensburg.de
Pongratz
Georg
G
Capellino
Silvia
S
Szeimies
Rolf M
RM
Schölmerich
Jürgen
J
Fleck
Martin
M
Salzberger
Bernd
B
Ehrenstein
Boris
B
D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D002481:Cellulitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D003646:Debridement; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006651:Histocytochemistry; D006801:Humans; D016867:Immunocompromised Host; D008853:Microscopy; D012867:Skin / Q000382:microbiology / Q000473:pathology; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D013256:Steroids; D015725:Fluconazole