title: Fatal primary cutaneous cryptococcosis: case report and review of published literature.
abstract: OBJECTIVE
  Cryptococcus is an opportunistic yeast with a worldwide distribution that primarily causes significant infections in immunocompromised individuals, generally by affecting the respiratory tract. But primary cutaneous cryptococcosis (PCC) without systemic infection is rare. We report a case of PCC in a patient with nephrotic syndrome.
  
  
  METHODS
  The 23-year-old man developed severe necrotising cellulitis on both the anterior and posterior of his trunk following a massage. He had been treated with systemic corticosteroids over 20 months for nephrotic syndrome. A skin biopsy of the wound area revealed cutaneous vasculitis and chronic inflammation with yeast-like organisms. Periodic acid-Schiff (PAS) staining indicated that the structures were consistent with Cryptococcus. A Cryptococcus neoformans infection was confirmed by culture. Azole therapy was begun, and the skin ulcers gradually stopped disseminating. However, the patient died following continuous capillary haemorrhage on the 22 day since admission.
  
  
  CONCLUSIONS
  Cryptococcus is crucial to be considered in the differential diagnosis of subcutaneous necrosis in any patient on immunosuppressive therapy.
authors.affiliation: National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, China.
authors.forename: H
authors.initials: H
authors.lastname: Qunpeng
authors.affiliation: National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, China.
authors.forename: X
authors.initials: X
authors.lastname: Shutian
authors.affiliation: National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University Clinical School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, China. xiehl_doctor@163.com.
authors.forename: X
authors.initials: X
authors.lastname: Honglang
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D003881:Dermatomycoses / Q000150:complications* / Q000188:drug therapy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy; D009894:Opportunistic Infections / Q000150:complications*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents
keywords: Cryptococcus; Primary cutaneous cryptococcosis