Primary cutaneous cryptococcosis in Brazil: report of 11 cases in immunocompetent and immunosuppressed patients.
BACKGROUND
Primary cutaneous cryptococcosis is an uncommon infectious disease caused by Cryptococcus neoformans or Cryptococcus gattii affecting immunosuppressed as well as immunocompetent patients. It is often misdiagnosed as it may mimic other cutaneous diseases.


METHODS
We report a series of cases diagnosed from 2005 to 2010 in two general hospitals. The diagnosis in all patients was made on the basis of histopathology and culture. Phenoloxidase and canavanine-glycine-bromothymol blue tests were used in order to identify the Cryptococcus species. Systematic investigation ruled out the systemic involvement in every case.


RESULTS
Eleven patients, 81.8% male, were diagnosed during this study. The immunosuppression status was identified in 54.5% of patients, and all of them were under corticosteroid therapy due to a variable set of diseases. All patients presented with circumscribed lesions on their upper limbs. Most lesions showed an infiltrative or tumoral aspect with up to 40 cm diameter. Fluconazole, up to 400 mg/daily, was the main therapeutic regimen and proved to be efficient.


CONCLUSIONS
Primary cutaneous cryptococcosis has been diagnosed in both immunosuppressed and immunocompetent patients. Its peculiar clinical aspect could facilitate early diagnosis. Culture and biochemical tests should be performed in order to define the species involved.
Department of Dermatology and Radiotherapy, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil. smarques@fmb.unesp.br
Sílvio A
SA
Marques
Ivander
I
Bastazini
Ana L G P
AL
Martins
Jaison A
JA
Barreto
Maria P
MP
Barbieri D'Elia
Joel C
JC
Lastória
Mariangela E A
ME
Marques
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil; D003453:Cryptococcosis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology*; D056285:Cryptococcus gattii; D003455:Cryptococcus neoformans; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology*
D000935:Antifungal Agents; D015725:Fluconazole