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Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report

BACKGROUND: Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cry...

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Autores principales: Probst, Corina, Pongratz, Georg, Capellino, Silvia, Szeimies, Rolf M, Schölmerich, Jürgen, Fleck, Martin, Salzberger, Bernd, Ehrenstein, Boris
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931510/
https://www.ncbi.nlm.nih.gov/pubmed/20699010
http://dx.doi.org/10.1186/1471-2334-10-239
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author Probst, Corina
Pongratz, Georg
Capellino, Silvia
Szeimies, Rolf M
Schölmerich, Jürgen
Fleck, Martin
Salzberger, Bernd
Ehrenstein, Boris
author_facet Probst, Corina
Pongratz, Georg
Capellino, Silvia
Szeimies, Rolf M
Schölmerich, Jürgen
Fleck, Martin
Salzberger, Bernd
Ehrenstein, Boris
author_sort Probst, Corina
collection PubMed
description BACKGROUND: Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis. CASE PRESENTATION: An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA). Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed. CONCLUSIONS: Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients.
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spelling pubmed-29315102010-09-02 Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report Probst, Corina Pongratz, Georg Capellino, Silvia Szeimies, Rolf M Schölmerich, Jürgen Fleck, Martin Salzberger, Bernd Ehrenstein, Boris BMC Infect Dis Case Report BACKGROUND: Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis. CASE PRESENTATION: An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA). Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed. CONCLUSIONS: Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients. BioMed Central 2010-08-11 /pmc/articles/PMC2931510/ /pubmed/20699010 http://dx.doi.org/10.1186/1471-2334-10-239 Text en Copyright ©2010 Probst et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Probst, Corina
Pongratz, Georg
Capellino, Silvia
Szeimies, Rolf M
Schölmerich, Jürgen
Fleck, Martin
Salzberger, Bernd
Ehrenstein, Boris
Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title_full Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title_fullStr Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title_full_unstemmed Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title_short Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
title_sort cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931510/
https://www.ncbi.nlm.nih.gov/pubmed/20699010
http://dx.doi.org/10.1186/1471-2334-10-239
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