Cryptococcus neoformans is an opportunistic germ, usually causing infections in immunocompromised patients. The main sources of infection with C. neoformans are excrement from birds, decomposing wood, fruit, and vegetables. Primary cutaneous cryptococcosis (PCC) is a clinical entity, differing from secondary cutaneous cryptococcosis and systematic infection. We report the case of an immunocompetent 60-year-old woman with PCC due to C. neoformans in her right thumb. She reported an accidental injury caused by a rose thorn while she was gardening. Clinical examination showed the presence of an erythematous ulcerated nodule with elevated borders, suppuration, and central necrosis. Skin histology examination showed cutaneous and subcutaneous fibrinoid necrosis with bleeding, abscess, neutrophil-rich cellular infiltration, and the presence of PAS-, Grocott- and mucin-positive spores. The mycological culture showed milky and creamy colonies of C. neoformans after 3 days. As there was no previous history of pulmonary cryptococcosis, we diagnosed PPC. We treated the patient surgically with accurate debridement of nonvital tissues in the right thumb. In addition, we started itraconazole treatment 100 mg twice daily for 6 months, which led to rapid clinical improvement without relapse. PCC is a rare infection that can present with quite unspecific clinical pictures including acneiform lesions, purpura, vesicles, nodules, abscesses, ulcers, granulomas, pustules, draining sinuses, and cellulitis. Prolonged systemic antifungal therapy is necessary in order to get a healing result without relapse. We summarize all the cases of PCC in immunocompetent patients published so far in the literature.
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机译:Cryptococcus Neoformans是一种机会主义的胚芽,通常会导致免疫血肿患者的感染。 C. Neoformans的主要感染源来自鸟类,分解木材,水果和蔬菜的粪便。初级皮肤阴性皮肤病(PCC)是一种临床实体,与次要皮肤阴性病变和系统感染不同。由于她的右拇指在右拇指中,我们举报了PCC的免疫活性60岁女性的案例。她报告说,在园艺的同时,玫瑰刺造成的意外伤害。临床检查表明,具有升高的边界,化妆和中央坏死的红细胞溃疡结节存在。皮肤组织学检查显示皮肤和皮下纤维蛋白骨蛋白坏死,具有出血,脓肿,富含性细胞浸润,以及PAS-,Grocott-和粘蛋白阳性孢子的存在。 Mycological文化在3天后显示乳白色和奶油菌落。由于之前没有肺部皮肤病病变,我们诊断出PPC。我们用右拇指中的非症状组织的准确清除术语,手术治疗患者。此外,我们每天两次开始服用伊曲康唑治疗,每天6个月,这导致了快速临床改善而不复发。 PCC是一种罕见的感染,可以在包括痤疮病变,紫癜,囊泡,结节,脓肿,溃疡,肉芽肿,脓疱,排水鼻窦和蜂窝织炎中的相当未指定的临床摄影。延长的全身抗真菌疗法是必要的,以便在不复发的情况下获得治疗结果。我们总结了在迄今为止文献中发表的免疫活性患者的所有PCC病例。
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