Primary Cutaneous Cryptococcus Following Traumatic Exposure: A Case Report and Retrospective Analysis

Main Article Content

Colin Burnette
Britney Lugmayer
Tara Snow
Charles Schirmer
Peter Mattei

Keywords

Primary Cutaneous Cryptococcus, Opportunistic Infections, Cryptococcal neoformans, Skin ulceration, Disseminated disease

Abstract

Primary cutaneous cryptococcus (PCC) is a form of Cryptococcal neoformans infection characterized by localized cutaneous colonization and proliferation. In this case study, we present PCC occurring following a previous trauma in a 77-year-old male with a history of renal organ transplant maintained by immunosuppressive therapy. Colonies of C. neoformans were successfully identified during a secondary workup after the patient had been misdiagnosed. Despite the delay in treatment, complete remission was achieved through aggressive antifungal therapy. Our case highlights common clinical pitfalls that contribute to the prolonged diagnosis of PCC. Our findings and retrospective analysis underscore commonalities in disease presentation, such as high-risk patient populations, transmission routes, and associated symptoms. Integrating these insights into clinical practice may heighten provider suspicion and enhance patient outcomes.

References

1. Tufa TB, Orth HM, Wienemann T, et al. Disseminated Cryptococcosis Is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and Is Associated with Higher Mortality Rates. J Fungi (Basel). Aug 9 2023;9(8)doi:10.3390/jof9080836

2. Srivastava GN, Tilak R, Yadav J, Bansal M. Cutaneous Cryptococcus: marker for disseminated infection. BMJ Case Rep. Jul 21 2015;2015doi:10.1136/bcr-2015-210898

3. Silva Souza CD, Takada MH, Ambiel MV, Nakai VT. Primary cutaneous cryptococcosis: the importance of early diagnosis. An Bras Dermatol. Jul-Aug 2021;96(4):482-484. doi:10.1016/j.abd.2020.12.004

4. Andrews L, Ralston S, Blomme E, Barnhart K. A snapshot of biologic drug development: Challenges and opportunities. Hum Exp Toxicol. Dec 2015;34(12):1279-85. doi:10.1177/0960327115603594

5. Christianson JC, Engber W, Andes D. Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol. Jun 2003;41(3):177-88. doi:10.1080/1369378031000137224

6. Kerr C, Stack WA, Sadlier C, Jackson A. Disseminated cryptococcal infection initially presenting as cryptococcal cellulitis in an HIV-negative patient on long-term steroids. BMJ Case Rep. Nov 28 2018;11(1)doi:10.1136/bcr-2018-227249

7. Henderson GP, Dreyer S. Ulcerative cellulitis of the arm: a case of primary cutaneous cryptococcosis. Dermatol Online J. Feb 15 2018;24(2)

8. Amaral DM, Rocha RC, Carneiro LE, Vasconcelos DM, Abreu MA. Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms. An Bras Dermatol. Sep-Oct 2016;91(5 suppl 1):29-31. doi:10.1590/abd1806-4841.20164582

9. Suranyi E, Maroon M, Tyler WB. Persistent cellulitis in a patient receiving renal dialysis. Cutis. Oct 2003;72(4):320-2.

10. Baumgarten KL, Valentine VG, Garcia-Diaz JB. Primary cutaneous cryptococcosis in a lung transplant recipient. South Med J. Jul 2004;97(7):692-5. doi:10.1097/00007611-200407000-00016

11. Devirgiliis V, Panasiti V, Borroni RG, et al. Cutaneous cryptococcosis in a patient affected by chronic lymphocytic leukaemia: a case report. Int J Immunopathol Pharmacol. Apr-Jun 2008;21(2):463-6. doi:10.1177/039463200802100227

12. Vogelaers D, Petrovic M, Deroo M, et al. A case of primary cutaneous cryptococcosis. Eur J Clin Microbiol Infect Dis. Feb 1997;16(2):150-2. doi:10.1007/bf01709474