Cutaneous Cryptococcosis Caused by Intravenous Line in Patient with Rheumatoid Arthritis

Seung Min Ryu; Doo Hyung Yoon; Kyu Jin Chung; Joon Hyuk Choi; Sam-Guk Park

doi:10.12790/jkssh.2017.22.3.208

Journal List > J Korean Soc Surg Hand > v.22(3) > 1106574

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Ryu, Yoon, Chung, Choi, and Park: Cutaneous Cryptococcosis Caused by Intravenous Line in Patient with Rheumatoid Arthritis

Original Article

J Korean Soc Surg Hand 2017;22(3):208-213.

Published online: 11 September 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.3.208

Cutaneous Cryptococcosis Caused by Intravenous Line in Patient with Rheumatoid Arthritis

Seung Min Ryu¹, Doo Hyung Yoon¹, Kyu Jin Chung², Joon Hyuk Choi³, Sam-Guk Park¹

¹Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea

²Department of Plastic Surgery, Yeungnam University Medical Center, Daegu, Korea

³Department of Pathology, Yeungnam University Medical Center, Daegu, Korea

Correspondence to: Sam-Guk Park Department of Orthopaedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea TEL: +82-53-620-3640 FAX: +82-53-628-4020 E-mail: radiorth@ynu.ac.kr

Received 4 July 201715 August 2017 Accepted 16 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococcus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.

Keywords: Cryptococcosis, Rheumatoid arthritis, Intravenous injection, Fluconazole, Amputation, Surgical flap

References

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Fig. 1.

(A) Preoperative photo. Large painful ulcerations and widespread cellulitis originated from intravenous line in the left forearm. (B) Intraoperative photo shows massive granulomatous tissues around extensor tendons and muscles.

Fig. 2.

(A) Histopathologic examination shows multiple round spores in necrotic tissue (H&E stain, ×200). (B) PAS stain shows reddish round spores (PAS stain, ×200).

Fig. 3.

(A) Intraoperative photo shows that skin and subcutaneous tissues were removed extensively above the fascias of extensor muscles due to progressive necrosis (one month after photographing Fig. 1). (B) Postoperative simple radiograph. After the second to fifth extensor tendons were removed, the interphalangeal joints were temporarily fixed with the Kirschner wires.

Fig. 4.

Two months after orthopedic surgery, second ray was also amputated for wound healing. Local advancement flap was performed immediately.

Fig. 5.

Eight months after orthopedic surgery. (A) The wound left hand was well healed, and the opposition of the thumb was possible. (B) Preservation of these 2 digits allowed to allow grasping large objects. (C) The wound of left forearm was also well healed. (D) Simple radiograph shows that second, fourth, and fifth rays were amputated.

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