title: Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition.
abstract: An 87-year old Caucasian male with past medical history of rheumatoid arthritis (RA) and chronic kidney disease presents with left hand erythema, pain, tenderness, induration and edema. Clinically, these hand findings began proximal to the metacarpo-phalangeal joints and extended to the distal wrist. He was noted to have ipsilateral axillary lymph node enlargement but denied any constitutional signs or symptoms. Laboratory markers of inflammation were poor prognostic indicators due to relatively active RA, the use of chronic daily glucocorticoids and weekly adalimumab use. Oral antibiotics were administered with limited success leading to a skin biopsy which reported a hematogenously disseminated fungal panniculitis; cultures grew Cryptococcus neoformans, however, serum cryptococcal antigen was negative. With initial fluconazole treatment, skin findings and lymphadenopathy improved gradually over the next six months. However, the patient's improvement stagnated and his condition reverted back to the state of initial presentation.
authors.affiliation: PASE Healthcare, PC, 225 Millburn Avenue, Suite 303, The Common, Millburn, NJ 07041, USA. ruigomesmd@gmail.com.
authors.forename: Rui M
authors.initials: RM
authors.lastname: Gomes
authors.affiliation: East Coast Advanced Plastic Surgery, 79 Hudson Street, Suite 700, Hoboken, NJ 07030, USA. dean@ecaplasticsurgery.com.
authors.forename: Dean R
authors.initials: DR
authors.lastname: Cerio
authors.affiliation: East Coast Advanced Plastic Surgery, 79 Hudson Street, Suite 700, Hoboken, NJ 07030, USA. cyrus@ecaplasticsurgery.com.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Loghmanee
authors.affiliation: Saint Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA. jmckinne@nyit.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: McKinney
authors.affiliation: PASE Healthcare, PC, 225 Millburn Avenue, Suite 303, The Common, Millburn, NJ 07041, USA. mpatel@pasehealthcare.com.
authors.forename: Mili
authors.initials: M
authors.lastname: Patel
authors.affiliation: PASE Healthcare, PC, 225 Millburn Avenue, Suite 303, The Common, Millburn, NJ 07041, USA. jmiraglia@pasehealthcare.com.
authors.forename: Janeen
authors.initials: J
authors.lastname: Miraglia
authors.affiliation: Infectious Disease Center of New Jersey, 22 Old Short Hills Road, Suite 106, Livingston, NJ 07039, USA. manalmd@aol.com.
authors.forename: Manal
authors.initials: M
authors.lastname: Yousef-Bessler
authors.affiliation: Weill Cornell Medical Center, New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA. jhzippin@med.cornell.edu.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Zippin
authors.affiliation: Weill Cornell Medical Center, New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA. ans9112@med.cornell.edu.
authors.forename: Audrey N
authors.initials: AN
authors.lastname: Schuetz
authors.affiliation: PASE Healthcare, PC, 225 Millburn Avenue, Suite 303, The Common, Millburn, NJ 07041, USA. pinhomd@pasehealthcare.com.
authors.forename: Paulo Bandeira
authors.initials: PB
authors.lastname: Pinho
keywords: Cryptococcus neoformans; TNF-α inhibitor; adalimumab; fluconazole; panniculitis