title: [Multiple facial nodules revealing disseminated cryptococcosis in an immunocompetent patient].
abstract: BACKGROUND
  Cryptococcosis is a potentially severe infection that usually occurs in a setting of immunosuppression. Its occurrence outside of this context is rare. We report a case of disseminated cryptococcosis revealed by a spectacular skin disease in an immunocompetent patient.
  
  
  METHODS
  A 40-year-old male patient had been presenting multiple nodules and tumors on his face for one month in a context of asthenia and intermittent fever. Histological examination of a skin biopsy revealed encapsulated yeasts strongly suggestive of Cryptococcus neoformans. Mycological examination of the skin biopsy and cerebrospinal fluid isolated Cryptococcus gattii. The blood cultures were positive. Brain MRI demonstrated cryptococcal parenchymal involvement. Screening for primary or secondary immunodeficiency was negative. The patient received amphotericin B 1mg/kg/day and fluconazole 600mg/day but died 2months after diagnosis.
  
  
  CONCLUSIONS
  Cryptococcosis is a potentially severe infection caused by C. neoformans. This rare condition occurs most commonly in patients with profound deficiency in terms of cellular immunity. Although rare, the occurrence of cryptococcosis in immunocompetent patients is possible, and in this event the signs are highly polymorphic, which usually makes it very difficult to diagnose. The diagnosis of cryptococcosis is based on the identification by direct examination and after staining with India ink of encapsulated yeasts of the Cryptococcus genus. Culture on Sabouraud medium is essential for identification of the species. Treatment for disseminated cryptococcosis involves amphotericin B, often associated with flucytosine IV. In the event of meningitis infection in non-HIV patients, mortality continues to be around 15%, despite adequate medical treatment.
  
  
  CONCLUSIONS
  Although rare, cryptococcosis can occur in immunocompetent subjects. The prognosis is severe even after treatment.
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc. Electronic address: hananerachadi@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Rachadi
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: K
authors.initials: K
authors.lastname: Senouci
authors.affiliation: Service de parasitologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: M
authors.initials: M
authors.lastname: Lyagoubi
authors.affiliation: Centre d'anatomie pathologique nations unies, 1, angle avenue des Nations Unies et rue Ibn Hanbal Agdal, 1090 Rabat, Maroc.
authors.forename: A
authors.initials: A
authors.lastname: Benzekri
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: S
authors.initials: S
authors.lastname: Mansouri
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: I
authors.initials: I
authors.lastname: Ramli
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: N
authors.initials: N
authors.lastname: Ismaili
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: B
authors.initials: B
authors.lastname: Hassam
authors.affiliation: Service de dermatologie-vénéréologie, CHU Ibn Sina, rue Famfdal Cherkaoui Rabat-Instituts, BP 6527, 10170 Rabat, Maroc.
authors.forename: L
authors.initials: L
authors.lastname: Benzekri
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D056285:Cryptococcus gattii / Q000302:isolation & purification*; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D017809:Fatal Outcome; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole
keywords: Amphotericin B; Amphotéricine B; Cryptococcose disséminée; Cryptococcus neoformans; Disseminated cryptococcosis; Facial nodules; Immunocompetent; Immunocompétent; Nodules du visage