Journal List > Tuberc Respir Dis > v.65(6) > 1001323

TOOLS
Choi, Lee, Lee, Yoo, Lee, and Kim: A Case of Disseminated Cutaneous Cryptococcosis Accompanied by Pulmonary Tuberculosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(6): 527-531.

Published online: 31 December 2008

DOI: https://doi.org/10.4046/trd.2008.65.6.527

A Case of Disseminated Cutaneous Cryptococcosis Accompanied by Pulmonary Tuberculosis

Hae Jin Choi, M.D.1, Sang Hwa Lee, M.D.2, Tae Hoon Lee, M.D.1, Kwang Ha Yoo, M.D.1, Kye Young Lee, M.D.1, Sun Jong Kim, M.D.1

1Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea.

2Department of Pathology, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea.

Address for correspondence: Sun Jong Kim, M.D. Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konkuk University Hospital, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-914, Korea. Phone: 82-2-2030-7523, Fax: 82-2-2030-7748, sjkim@kuh.ac.kr

Received 24 September 2008       Accepted 27 October 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Although disseminated cryptococcosis occurs most commonly in immunocompromised patients, particularly those with a human immunodeficiency virus (HIV) infection, it can occur in immune competent persons. There are no case reports of disseminated cutaneous crytpcoccosis associated with pulmonary tuberculosis in Korea. A 71-year-old female presented with fever and multiple cutaneous nodules. She was finally diagnosed with disseminated cutaneous cryptococcosis accompanied by pulmonary tuberculosis, and was treated successfully with anti-tuberculous medication and fluconazole. She had no apparent predisposing conditions for systemic cryptococcosis. We report this case with a review of the relevant literature.

Keywords: Cryptococcosis, Tuberculosis

Figures and Tables

Figure 1
Ulcerative skin lesions were showed on dorsum of left hand and medial side of left upper arm after first debridement.
trd-65-527-g001
Figure 2
Initial chest X-ray showed increased interstitial markings on both lungs and consolidation on both lower lung fields.
trd-65-527-g002
Figure 3
Chest CT on admission showed bilateral small nodules scattered on both lungs (thin arrow) and bilateral pulmonary embolisms (thick arrow).
trd-65-527-g003
Figure 4
Microabscess with numerous round to oval fungal spores is noted in the dermis and subcutaneous tissue (H&E stain, ×400).
trd-65-527-g004
Figure 5
Numerous encapsulated fungal spores, morphologically consistent with cryptococcus, are stained by Gomori's methenamine siver stain and show black color (GMS stain, ×1,000).
trd-65-527-g005
Figure 6
Skin lesions of the patient were completely healed after treatment.
trd-65-527-g006

References

1. Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis. 2001. 33:690–699.
2. Park SH, Choi SM, Kim YR, Lee DG, Kim SI, Wie SH, et al. A case of disseminated cryptococcosis in an immunocompetent adult. Infect Chemother. 2004. 36:245–250.
3. Kim YJ, Seo SJ, Ro BI. A case of primary cutaneous cryptococcosis misdiagnosed as skin tuberculosis. Korean J Med Mycol. 2003. 8:16–20.
4. Rheu SH, Lim JS, You DS, Shin WH, Rheu IH, Yoon SJ, et al. A case of pulmonary cryptococcosis in healthy person. Tuberc Respir Dis. 1996. 43:102–107.
5. Catanzaro A. Bordow RA, Reis AL, Morris TA, editors. Crytococcosis and actinomycosis. Manual of clinical problems in pulmonary medicine. 2000. Philadelphia: Lippincott Williams & Wilkins;195–201.
6. Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev Infect Dis. 1991. 13:1163–1169.
7. Lee MY, Chung JH, Shin JH, Hwang TJ, Kim KS, Lee JH, et al. Lymphonodular cryptococcosis diagnosed by fine needle aspiration cytology in hyper-IgM syndrome: a case report. Acta Cytol. 2001. 45:241–244.
8. Sorensen RU, Boehm KD, Kaplan D, Berger M. Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency. J Pediatr. 1992. 121:873–879.
9. Zaharatos GJ, Behr MA, Libman MD. Profound T-lymphocytopenia and cryptococcemia in a human immunodeficiency virus-seronegative patient with disseminated tuberculosis. Clin Infect Dis. 2001. 33:E125–E128.
10. Al-Tawfiq JA, Ghandour J. Cryptococcus neoformans abscess and osteomyelitis in an immunocompetent patient with tuberculous lymphadenitis. Infection. 2007. 35:377–382.
11. Kahn FW, England DM, Jones JM. Solitary pulmonary nodule due to Cryptococcus neoformans and Mycobacterium tuberculosis. Am J Med. 1985. 78:677–681.
12. Kokturk N, Ekim N, Kervan F, Arman D, Memis L, Caglar K, et al. Disseminated cryptococcosis in a human immunodeficiency virus-negative patient: a case report. Mycoses. 2005. 48:270–274.
13. Manfredi R, Calza L. Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China. Int J Infect Dis. 2008. 12:438–441.
14. Schupbach CW, Wheeler CE Jr, Briggaman RA, Warner NA, Kanof EP. Cutaneous manifestations of disseminated cryptococcosis. Arch Dermatol. 1976. 112:1734–1740.
15. Revenga F, Paricio JF, Merino FJ, Nebreda T, Ramirez T, Martinez AM. Primary cutaneous cryptococcosis in an immunocompetent host: case report and review of the literature. Dermatology. 2002. 204:145–149.
16. Xiujiao X, Ai'e X. Two cases of cutaneous cryptococcosis. Mycoses. 2005. 48:238–241.
17. Saag MS, Graybill RJ, Larsen RA, Pappas PG, Perfect JR, Powderly WG, et al. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis. 2000. 30:710–718.
TOOLS
Similar articles