• Users Online: 272
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 15  |  Issue : 1  |  Page : 30-31

Disseminated cryptococcosis with localized cutaneous lesion in an AIDS patient


1 Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya District, India
2 Department of Microbiology, Bowring and L. C. Hospital, Bangalore, Karnataka, India
3 Department of Dermatology, Bowring and L. C. Hospital, Bangalore, Karnataka, India
4 Department of Pathology, Bowring and L. C. Hospital, Bangalore, Karnataka, India

Date of Web Publication3-Aug-2013

Correspondence Address:
D Vijaya
Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya District
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1282.116095

Rights and Permissions
  Abstract 

A case of Cryptococcus neoformans causing localized cutaneous lesion over the left upper lip in an acquired immunodeficiency syndrome (AIDS) patient with cryptocococcal meningitis and pulmonary tuberculosis.

Keywords: AIDS, Cryptococcus neoformans, meningitis


How to cite this article:
Vijaya D, Nagaratnamma T, Leelavathy B, Kumar VV. Disseminated cryptococcosis with localized cutaneous lesion in an AIDS patient. J Acad Clin Microbiol 2013;15:30-1

How to cite this URL:
Vijaya D, Nagaratnamma T, Leelavathy B, Kumar VV. Disseminated cryptococcosis with localized cutaneous lesion in an AIDS patient. J Acad Clin Microbiol [serial online] 2013 [cited 2022 Jan 28];15:30-1. Available from: https://www.jacmjournal.org/text.asp?2013/15/1/30/116095


  Introduction Top


Cryptococcus neoformans is the most common cause of fungal meningitis especially among immunocompromized patients. Hematogenous lesions of the skin occur in about 10% of patients with Cryptococcosis. Skin lesions help in the early diagnosis of disseminated Cryptococcosis. [1] Here we report a rare case of Cryptococcus neoformans causing localized cutaneous lesion over the left upper lip in an acquired immunodeficiency syndrome (AIDS) patient with cryptocococcal meningitis and pulmonary tuberculosis.


  Case Report Top


A 30-year-old human immunodeficiency virus (HIV) seropositive male patient was referred to Dermatology Department of Bowring and L. C. Hospital, Bangalore on September 19, 2007 with history of gradually increasing painless swelling over his left upper lip since one month. Patient was on antituberculosis treatment (ATT) for pulmonary tuberculosis since one month and his HIV status was known since 6 months.

On examination

Well built male patient, afebrile. Pulse: 92/min, regular, blood pressure: 110/60 mmHg. Local examination of the swelling revealed painless lesion over left lip, 3 × 3 cm in diameter with ulceration draining thin exudates [Figure 1] with bilateral supraclavicular lymphadenopathy. No similar skin lesions were found in other parts of the body.
Figure 1: Cutaneous cryptococcosis - ulcerated lesion over left upper lip

Click here to view


CNS examination

Signs of meningitis were detected.

Investigations

Blood routine: ESR: 60 mm/h
CD4 count: 95 cells/mm 3 , CD8: 1739 cells/mm 3 , CD4/CD8:0.05.
Mantoux test - Negative, VDRL - Nonreactive, TPHA - Negative.

Chest X-ray - Suggestive of pulmonary tuberculosis with mediastinal lymphadenopathy. Computed tomography (CT) scan of brain: Mild cerebral atrophy.

CSF analysis

Protein - 121 mg/dl, Sugar - 41 mg/dl, cell count of 30/mm 3 , granulocytes 25, lymphocytes 5. Gram stain showed gram positive budding yeast cells and nigrosin staining showed numerous capsulated budding yeast.

Direct examination of the aspirate from the skin lesion

Gram stain, Budding yeast cells with capsule were seen [Figure 2].
Figure 2: Grams stain of aspirate showing budding yeast cells

Click here to view


KOH preparation - Positive for yeast cells, with capsule. Nigrosin preparation - showed budding yeast cells with capsule.

H and E stain - Yeast cells surrounded by wide capsule with little inflammatory reaction, PAS stain - Showing yeast cells with capsule.

Culture

Sabouraud dextrose agar showed cream colored shiny, moist and mucoid colonies. Isolate was identified as Cryptococcus neoformans based on gram stain showing Gram positive budding capsulated yeast cells, nigrosin preparation showing capsulated yeast cells, positive urease test, growth at 37°C and brown colored colonies on Niger seed agar.


  Discussion Top


Cryptococcosis is an infection caused by the encapsulated fungus Cryptococcus neoformans.[1] Cryptococcosis is an important herald of the advanced stages of HIV infection, occurring when the CD4 count is less than 200/mm 3 . [2] The mortality rate of disseminated Cryptococcosis is 70-80% in untreated patients compared with those treated with systemic antifungal agents. [3] Previous study from our hospital showed that 6.25% of the AIDS cases had Cryptococcal meningitis. [4] Patient was treated with Amphotericin B 0.75 mg/kg/day for 2 weeks, which was changed to Fluconazole - 400 mg/day for 8 weeks. He responded well to treatment and the swelling started regressing in 3 weeks. After complete cure he was discharged.

From Bowring and L.C. Hospital, we have reported a case of advanced stage of AIDS with disseminated cryptococcosis, involvement of CNS, lungs and skin and a second case of disseminated cutaneous cryptococcosis in an immunocompetent patient. [5],[6] This is the second report of disseminated cryptococcosis with localized cutaneous lesion in an AIDS patient from Bowring and L.C. Hospital Bangalore.

 
  References Top

1.Kwon Chung KJ, Bennett JE. Cryptococcosis. Medical Mycology. 1 st edn. Philadelphia: Lea and Febiger; 1992;16:397-447.  Back to cited text no. 1
    
2.Dharmshale SN, Patil SA, Gohil A, Chowdary A, Oberoi C. Disseminated Cryptococcosis with extensive involvement in AIDS. Indian J Med Microbiol 2006;23:228-30.  Back to cited text no. 2
    
3.Aberg JA, Poroderly WG. Cryptococcosis and HIV. http://hivinsite.ucsf.edu/ (Last accessed on 2012 Dec 12).  Back to cited text no. 3
    
4.Vijaya D, Chandramma L, Anand Kumar BH. Oppurtunistic infection in AIDS cases at Bowring and LC Hospital, Bangalore. Karnataka J Med Sci 2000;5:96-8.  Back to cited text no. 4
    
5.Vijaya D, Anand Kumar BH, Malini A, Mahantesh. Disseminated Cryptococcosis with cutaneous lesion in an AIDS patient. J Acad Clin Microbiol 2003;5:33-6.  Back to cited text no. 5
    
6.Vijaya D, Anand Kumar BH. Disseminated Cryptococcosis with cutaneous lesion in an immunocompetent patient. Mycoses 2001;44:113-4.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed2652    
    Printed130    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal