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CASE REPORT
Year : 2002  |  Volume : 20  |  Issue : 3  |  Page : 165-166
 

Cutaneous cryptococcosis among HIV infected patients


Department of (RSS, GM), Perundurai Medical College, Perundurai - 638 053, Tamil Nadu, India

Correspondence Address:
Department of (RSS, GM), Perundurai Medical College, Perundurai - 638 053, Tamil Nadu, India

 ~ Abstract 

Five patients with HIV associated cutaneous cryptococcal infection are reported.

How to cite this article:
Vasanthi S, Padmavathy B K, Gopal R, Sundaram R S, Manoharan G. Cutaneous cryptococcosis among HIV infected patients. Indian J Med Microbiol 2002;20:165-6


How to cite this URL:
Vasanthi S, Padmavathy B K, Gopal R, Sundaram R S, Manoharan G. Cutaneous cryptococcosis among HIV infected patients. Indian J Med Microbiol [serial online] 2002 [cited 2020 Aug 8];20:165-6. Available from: http://www.ijmm.org/text.asp?2002/20/3/165/6945


Meningitis is the most common clinical manifestation of cryptococcosis. Haematogenous lesions of the skin occur in about 10% of patients with cryptococcosis. The significance of skin lesion is in the early diagnosis of disseminated cryptococcosis.[1] Cases of cutaneous cryptococcosis diagnosed in our institution is reported here because of its rarity and paucity of such reports in this region of the country to the best of our knowledge.

 ~ Case Report Top

A total of 5 cases of cutaneous cryptococcosis were diagnosed over a period of 3 months among HIV infected patients. Four of the five cases presented with complaints of headache and/or vomiting of variable duration of one to three weeks while other case presented with diarrhoea and vomiting of about one week duration. Maculopapular skin lesions over the face and/or trunk were seen in all the cases [figure]. Cervical lymphadenopathy was evident in one case while enlarged liver and spleen were found in two cases. Cerebrospinal fluid was positive for Cryptococcus by microscopy and culture in three of the five cases while skin lesions were positive for Cryptococcus in all the five cases by microscopy and culture.

 ~ Discussion Top

Cutaneous lesions of cryptococcosis are usually characterised by multiple, discrete, flesh to red coloured papules varying in size from 1-6 mm and often slightly umbilicated, resembling molluscum contagiosum.[2] It is often necessary to take biopsy and culture papular skin lesions thought to be molluscum contagiosum to exclude the more serious condition of cryptococcosis.[3] Histopathological examination of the lesions in the cases reported here were negative for molluscum bodies and culture of the samples yielded C. neoformans thus confirming the diagnosis of microscopic findings viz India ink and Gram stain. Cutaneous manifestations can precede and be the sole clue to disseminated cryptococcal infection.[4]
Skin findings in disseminated cryptococcosis indicate a poor prognosis.[5] However, early recognition and treatment would improve survival. Two of the patients reported in this study died during the course of their stay and one patient showed deterioration in the clinical status manifested by convulsions and coma. Thus the prognosis for these patients is poor and early diagnosis may be helpful. A high index of suspicion of the probability of cutaneous cryptococcosis in these patients is necessary as the lesions can mimick a variety of dermatological diseases like molluscum contagiosum, Kaposi's sarcoma etc. 

 ~ References Top

1.Kwon-Chung KJ, Bennett JE. (Eds) Medical Mycology, (Lea and Febiger) 1992:406.  Back to cited text no. 1    
2.Mandell GL. (Ed) Atlas of Infectious Disease, Vol. I, AIDS, (Churchill Livingstone) 1995:5.5  Back to cited text no. 2    
3.Cockerell CJ, Fridman-Kien AE. In : Textbook of AIDS Medicine, (Eds) Broders, Merigan TC Jr, Bolognesi D. (Williams & Wilkins) 1994:p515  Back to cited text no. 3    
4.Pema K, Diazj, Guerra-LG, Nabhan D, Verghese A, Disseminated cutaneous cryptococcosis-comparison of clinical manifestation in the AIDS and pre AIDS Era. Arch internal Med 1994;154:1032-4.  Back to cited text no. 4    
5.Sulica RL, Kelly J, Berberian BJ, Glaun R. Cutaneous Cryptococcosis with Molluscum contagiosum coinfection in a patient with AIDS. J Med Assoc Thai 1994;77:322-6.  Back to cited text no. 5    
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