Mixed Pneumocystis and Cryptococcus cutaneous infection histologically mimicking xanthoma.
Cutaneous Pneumocystis jirovecii infection is rare. It is thought that the disease emerges from a latent infection delivered via hematogenous and/or lymphatic dissemination from a primary lung infection in immunocompromised individuals. A 32-year-old human immunodeficiency virus-positive male was admitted for headache and vomiting. He was diagnosed with meningitis due to Cryptococcus neoformans and sputum tested positive for Pneumocystis. Six months later, he presented with a slightly crusted yellowish brown plaque and 2 similar but smaller papules with telangiectasia near the right angle of the mouth. Biopsy of the area featured histiocytes expanded by foamy cytoplasm as in a xanthoma except that the vacuoles were coarser. Special stains ultimately demonstrated the characteristic disks of Pneumocystis accompanied by a minor component of budding yeasts (Cryptococcus) in the same fields. This case illustrates the utility of adequate special stains in recognizing a mixed cutaneous infection, particularly in human immunodeficiency virus-positive patients, when microscopy presents an odd xanthoma-like lesion.
Creighton University School of Medicine, Omaha, NE, USA.
Zachary G
ZG
Peña
Hugh R
HR
Byers
Larisa M
LM
Lehmer
Carolyn A
CA
Smith
Bruce D
BD
Ragsdale
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D060085:Coinfection; D003453:Cryptococcosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D003455:Cryptococcus neoformans / Q000472:pathogenicity*; D003881:Dermatomycoses / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D016720:Pneumocystis Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D045363:Pneumocystis carinii / Q000472:pathogenicity*; D011237:Predictive Value of Tests; D012867:Skin / Q000187:drug effects / Q000382:microbiology / Q000473:pathology*; D013194:Staining and Labeling; D016896:Treatment Outcome; D014973:Xanthomatosis / Q000473:pathology*
D000935:Antifungal Agents