Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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Indexed in KCI, KoreaMed, Synapse, DOAJ
Open Access, Peer Reviewed
pISSN 2288-0585 eISSN 2288-6850

Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing’s Syndrome: A Case Report and Review of the Literature

Case report

Annals of Clinical Microbiology (Ann Clin Microbiol) 2012 June, Volume 15, Issue 2, pages 70-73.

https://doi.org/10.5145/ACM.2012.15.2.70

Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing’s Syndrome: A Case Report and Review of the Literature

Young Jin Ko, Mi Hyun Hong, Chul-Min Park, Hee-Won Moon, Mina Hur, Yeo-Min Yun

Department of Laboratory Medicine, Konkuk University School of Medicine and Medical Center, Seoul, Korea

Abstract

Cryptococcus neoformans (C. neoformans) is a ubiquitous yeast-like fungus that has been a common opportunistic human pathogen, especially in immunocompromised patients. Although skin lesions due to C. neoformans are found in 10-15% of patients with systemic cryptococcosis, primary cutaneous cryptococcosis without systemic infection is rare and now considered a distinct clinical entity. We report a case of primary cutaneous cryptococcosis in a patient with iatrogenic Cushing’s syndrome. A 73-year-old woman presented with pain and discharge from lesions on her left forearm. The patient had been treated with oral corticosteroids for 20 years, and as a result had developed iatrogenic Cushing’s syndrome. A skin fragment of the ulcer was cultured, and the encapsulated fungus were isolated and identified as C. neoformans using a Vitek2 system (Vitek2 ID-YST, bioMérieux, France) and API 20C (bioMérieux). Concurrent blood and urine cultures were negative for growth. At first, she was treated with antibiotics due to suspicion of cellulitis. After surgical resection and treatment with systemic and oral fluconazole, her wound was improved with scar. Primary cutaneous cryptococcosis should be considered when skin lesions are not responsive to antibiotics and accurate identification is important for proper treatment. (Korean J Clin Microbiol 2012;15:70-73)

Keywords

Cryptococcus neoformans, Cushing’s syndrome, Primary cutaneous cryptococcosis