Three had exposure to soil or pigeon droppings.
#Cryptococcus neoformans india ink skin
Quereux5 described PCC in four cases in HIV negative patients who had solitary skin lesions and improved with Fluconazole. For immunocompetent hosts with non-CNS cryptococcal infection including cutaneous disease, the treatment is oral azole therapy (Fluconazole) for 36 months.4 Our patient had shown good improvement after 4 weeks treatment with Fluconazole, but could not be followed up further. The treatment for cryptococcal disease depends upon the anatomic site of involvement and the host's immune status. Skin lesions associated with PCC are usually single, confined to a limited area and present as papules, nodules, cellulitis, ulceration and whitlow.2 In a study from India, Vasanthi et al3 reported 5 cases of cutaneous cryptococcosis in HIV positive patients, all of whom has maculopapular skin lesions over the face and trunk. Primary cutaneous cryptococcosis is an uncommon clinical entity. The organism usually affects the central nervous system, and the lungs, though extrapulmonary sites can also be involved. The route of infection is by inhalation of aerosolized particles from the environment. However, the patient has not come for follow-up since then.Ĭryptococcus neoformans is a ubiquitous saprophytic fungus with worldwide distribution. There was substantial regression of the nodule and the treatment was continued for another four weeks and complete excision was suggested. He was treated with oral Fluconazole 200 mg twice daily for four weeks. On further questioning, he gave history of regular cleaning of pigeon droppings from his terrace 2 months prior to the formation of the nodule. Absolute CD4 count was 481 cells/mm3 (normal 290-2800). HIV ELISA by three different kits was negative. The yeast was identified as Cryptococcus neoformans by the urease test and production of brown pigmentation on caffeic acid medium. Culture of the aspirated material was done on Sabouraud's medium at 37oC and mucoid yeast-like growth was obtained after 72 hours of incubation. The Gram stain revealed gram positive budding yeast cells an India ink preparation revealed encapsulated yeast cells (Fig. This was PAS positive and mucicarmine positive. Histopathology report was suggestive of granulomatous inflammation due to Cryptococcus. His chest X-ray was normal.Ī fine needle aspiration of the nodule was done. Biochemical profile including blood sugar was normal. Investigations revealed a white cell count of 6,900 cells/mm3 with 65% neutrophils, 33% lymphocytes and 2% eosinophils. There were no such nodules anywhere else in the body. His general and systemic examination did not reveal any abnormalities. On examination, there was a firm, non-tender, 2 cms x 1 cm subcutaneous nodule over the right abdomen, below the right costal margin (Fig. There was no history of local injury at the site of the nodule, fever, headache, cough or diabetes. Case ReportĪ 32 year old male, presented with complaints of a painless nodule in the right upper abdominal wall since one month. The presence of cutaneous lesions may be an early marker of disseminated disease.1 However, primary cutaneous cryptococcosis (PCC) has been seen to occur in immunocompetent as well as immunocompromised individuals.2 We report herein a case of primary cutaneous cryptococcosis in an immunocompetent male seen at our hospital. neoformans are found in approximately 5% of patients with cryptococcal meningitis and are attributable to haematogenous dissemination. © IntroductionĬryptococcus neoformans is an encapsulated yeast responsible for meningitis in immunocompromised hosts.
He improved on treatment with oral Fluoconazole. Cryptococcus neoformans was isolated from the lesion and no underlying disorder could be detected. He gave a history of exposure to pigeon droppings. We report a case of an apparently immunocompetent male, who presented with a painless nodule over the upper abdominal wall.
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