Indian Journal of Dermatology
CASE REPORT
Year
: 2006  |  Volume : 51  |  Issue : 3  |  Page : 202--203

AIDS defining disease: Disseminated cryptococcosis


Anupama Roshan, CR Janaki, GS Selvi, B Parveen, N Gomathy 
 Department of Dermatology, Madras Medical College, India

Correspondence Address:
C R Janaki
Old No. 53, New No. 2, East Park Road, Shenoy Nagar, Chennai - 30. Tamil Nadu
India

Abstract

Disseminated cryptococcosis is one of the acquired immune deficiency syndrome defining criteria and the most common cause of life threatening meningitis. Disseminated lesions in the skin manifest as papules or nodules that mimic molluscum contagiosum (MC). We report here a human immunodeficiency virus positive patient who presented with MC like lesions. Disseminated cryptococcosis was confirmed by India ink preparation and histopathology. The condition of the patient improved with amphotercin B.



How to cite this article:
Roshan A, Janaki C R, Selvi G S, Parveen B, Gomathy N. AIDS defining disease: Disseminated cryptococcosis.Indian J Dermatol 2006;51:202-203


How to cite this URL:
Roshan A, Janaki C R, Selvi G S, Parveen B, Gomathy N. AIDS defining disease: Disseminated cryptococcosis. Indian J Dermatol [serial online] 2006 [cited 2020 Jul 5 ];51:202-203
Available from: http://www.e-ijd.org/text.asp?2006/51/3/202/27988


Full Text

 Introduction



Cutaneous cryptococcosis is a sign of dissemination in approximately 10% of cases and may precede life threatening disease by several weeks.[1],[2] The lesions may vary greatly in morphology and mimic many other dermatological entities. They may be misdiagnosed as molluscum contagiosum[3] or penicillium marneffei. Other presentations include papules, tumors, plaques, vesicles, abscess, purpura, draining sinuses, ulcers, bullae or subcutaneous swelling.

 Case Report



A 45 years old male patient, recently diagnosed as a case of HIV infection with pulmonary tuberculosis, presented with skin lesions all over the body of 2 months duration. He also developed difficulty in swallowing. Later he developed altered sensorium. Patient was poorly built and nourished.

Systemic examination of the respiratory system was suggestive of pulmonary tuberculosis and that of CNS revealed features of meningitis. Cutaneous examination showed multiple umbilicated papules varying in size from 0.5 to 2 cms over the face, trunk and extremities [Figure 1].

Glossitis was present. With the above features, a differential diagnosis of molluscum contagiosum, cryptococcosis and penicillosis were considered.

Hematological and biochemical investigations were within normal limits. CD 4 count was 64 cells/cu mm. Scraping of the tongue showed peudohyphae and budding yeast cells of candidal spp. CSF revealed numerous budding yeast cells with broad unstained capsules [Figure 2]. Culture of cutaneous lesions and blood on SDA showed rapidly growing yellow colonies [Figure 3] consistent with cryptococcus species.

Histopathological examination in haematoxylin and eosin stain revealed thinned out epidermis with gelatinous infiltrate [Figure 4]. The patient was started on Inj. amphotercin B and fluconazole IV for 14 days.

The patient was the lost for further follow up.

 Discussion



Disseminated skin lesions caused by cryptococcosis is one of the AIDS defining criteria. Cryptococcosis commonly presents as subacute meningitis or meningoencephalitis with fever, malaise and headache. Approximately 5% of HIV infected individuals develop disseminated cryptococcosis. Most common skin lesions are molluscum contagiosum like lesion.[3]

A high degree of suspicion and various investigative modalities will lead to earlier diagnosis. More recently monoclonal antibody designated TC 5 and TC 9 recognize both encapsulated and non-encapsulated isolates of this pathogen.[4]

This is the second case reported from our centre and in the previous case, we did not find evidence of meningitis.[5] This HIV patient with pulmonary TB, candidal glossitis, with reduced CD 4 count showed clinically disseminated cutaneous lesions and meningitis. A high degree of suspicion of cryptococcosis was later confirmed through mycological investigations. Simple mycological investigations of cutaneous lesions and CSF enable us to arrive easily at the diagnosis. In addition, histopathological examination confirmed the diagnosis of cryptococcosis.

Treatment options include amphotericin B 0.7 mg/kg IV. Since fluconazole crosses the blood brain barrier it can be useful in patients with meningitis. Patients should also be maintained life long on tab fluconazole 200-400 mgs daily.[6]

References

1Murakawa GJ, Kershmannk, Berger T. Cutaneous cryptococcosis infection and AIDS. Arch Dermatol 1996;132:545-8.
2Ricchi E, Manfredi R, Scarani P, et al . Culaneous cryptoccosis and AIDS. J Am Acad Dermatol 1991;335-6.
3Durden FM, Elewski B. Cutaneous involvement with Cryprococcosis neoformans in AIDS. J Am Acad Dermatol 1994;30:844-8.
4Hamilton AJ, Bartholomew MA, Figure J, et al . Production of Sp specific murine antibodies against cryptococcous neoformans which recognize a nmc cap Ag. J Clin Microbiol 1991;29:980-4.
5Rajetha, C. Janaki, Gentamil Selvi Selvi G. et al . Disseminated cutaneous Cryptococcosis in a patient with HIV. Indian J Dermatol 2004;49.
6Powederly WG. Medscape fungal infections- Diagnosis and management in patients with HIV disease. CME.