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Cutaneous Cryptococcus Infection and AIDS: Report of 12 Cases and Review of the Literature

Cutaneous Cryptococcus Infection and AIDS: Report of 12 Cases and Review of the Literature Abstract Background: Cryptococcal infections occur in 6% to 13% of patients with acquired immunodeficiency syndrome (AIDS), most commonly infecting the central nervous system. Cutaneous lesions have been described morphologically as umbilicated papules, nodules, and violaceous plaques and can mimic molluscum contagiosum and Kaposi's sarcoma. Cutaneous lesions can present months prior to other signs of systemic infection. Observations: Cases of infection with cutaneous Cryptococcus and AIDS were reviewed and compared with cases reported in the literature. Among patients with Cryptococcus infection and AIDS seen at our institutions, 5.9% had skin lesions. All patients with cutaneous lesions had systemic involvement. Women were less commonly infected than men. There was no apparent predisposition associated with age, race, or human immunodeficiency virus infection risk factors. The median CD4 helper T-cell count was 0.024×109/L (24/ μL), and 44% (16/36) of the patients had previous opportunistic infections. Lesions were most commonly seen on the head and neck (78% [36/46]) and often mimicked molluscum contagiosum (54% [25/46]). The median serum and cerebrospinal fluid cryptococcal antigen titers were 1:32 768 and 1:512, respectively. Patients in our group did well with therapy (one death at 6 weeks, compared with 38% [13/34] mortality in the literature). There was no correlation between onset of lesions, number of lesions, CD4 helper T-cell count, or histopathologic characteristics. Conclusions: Disseminated Cryptococcus infection in AIDS presents with cutaneous lesions in up to 6% of cases. Clinicians need to be aware of the varied morphologic characteristics, since cutaneous lesions may present well in advance of other signs of systemic infection.(Arch Dermatol. 1996;132:545-548) References 1. Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis . Rev Infect Dis. 1991;13:1163-1169.Crossref 2. Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome . N Engl J Med. 1989;321:794-799.Crossref 3. Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated Cryptococcus . J Am Acad Dermatol. 1995;32:844-850.Crossref 4. Pema K, Diaz J, Guerra LG, Nabhan D, Verghese A. Disseminated cutaneous cryptococcosis: comparison of clinical manifestations in the pre-AIDS and AIDS era . Arch Intern Med. 1994;154:1032-1034.Crossref 5. Durden FM, Elewski B. Cutaneous involvement with Cryptococcus neoformans in AIDS . J Am Acad Dermatol. 1994;30:844-848.Crossref 6. Lui H, McLeod WA, Wood WS. An ulcerated plaque in a gay man . Arch Dermatol. 1993;129:495-500.Crossref 7. Blauvelt A, Kerdel FA. Cutaneous cryptococcosis mimicking Kaposi's sarcoma as the initial manifestation of disseminated disease . Int J Dermatol. 1992;31: 279-280.Crossref 8. Ghigliotti G, Carrega G, Farris A, et al. Cutaneous cryptococcosis resembling molluscum contagiosum in a homosexual man with AIDS . Acta Derm Venereol. 1992;72:182-184. 9. Manrique P, Mayo J, Alvarez JA, et al. Polymorphous cutaneous cryptococcosis: nodular, herpes-like, and molluscum-like lesions in a patient with the acquired immunodeficiency syndrome . J Am Acad Dermatol. 1992;26:122-124.Crossref 10. Cusini M, Cagliani P, Grimalt R, et al. Primary cutaneous cryptococcosis in a patient with the acquired immunodeficiency syndrome . Arch Dermatol. 1991; 127:1848-1849.Crossref 11. Ricchi E, Manfredi R, Scarani P, Costigliola P, Chiodo F. Cutaneous cryptococcosis and AIDS . J Am Acad Dermatol. 1991;25:335-336.Crossref 12. Shahab ST, Habte-Gabr E, Fedorko D. Significance of crypotococcal antigen titers in patients with AIDS . South Med J. 1991;84:1407-1408.Crossref 13. Poizot-Martin I, Grob JJ, Fournerie JR, et al. Cryotococcose cutanée à forme de molluscum contagiosum au cours du SIDA: un cas . Ann Dermatol Venereol. 1991;118:29-32. 14. Sofman MS, Heilman ER. Simultaneous occurrence of Kaposi's sarcoma and Cryptococcus within a cutaneous lesion in a patient with acquired immunodeficiency syndrome . Arch Dermatol. 1990;126:683-684.Crossref 15. Pierard, GE, Pierard-Franchimont C, Estrada JA, Rurangirwa A, Dosal FL. Cutaneous mixed infections in AIDS . Am J Dermatopathol. 1990;12:63-66.Crossref 16. Mares M, Sartori MT, Carretta M, Bertaggia A, Girolami A. Rhinaphyma-like cryptococcal infection as an early manifestation of AIDS in a hemophilia B patient . Acta Haematol. 1990;84:101-103.Crossref 17. Jones C, Orengo I, Rosen T, Ellner K. Cutaneous cryptococcosis simulating Kaposi's sarcoma in the acquired immunodeficiency syndrome . Cutis. 1990; 45:163-167. 18. Azon-Masoliver A, Gonzalez-Clemente J, Pedrol E, et al. Herpetiform and mollusca contagiosa-like cutaneous cryptococcosis in a patient with AIDS . Br J Dermatol. 1989;121:665-667.Crossref 19. Picon L, Vaillant L, Duong T, et al. Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS . Acta Derm Venereol. 1989; 69:365-367. 20. Miller SJ. Cutaneous Cryptococcus resembling molluscum contagiosum in a patient with acquired immunodeficiency syndrome . Cutis. 1988;41:411-412. 21. Concus AP, Helfand RF, Imber MJ, Lerner EA, Sharpe RJ. Cutaneous cryptoccosis mimicking molluscum contagiosum in a patient with AIDS . J Infect Dis. 1988;158:897-898.Crossref 22. Libow LF, Dobert D, Sibulkin D. Co-existent cutaneous cryptococcosis and Kaposi's sarcoma in a patient with the acquired immodeficiency syndrome . Cutis. 1988;41:159-162. 23. Jimenez-Acosta F, Casado M, Borbujo J, et al. Cutaneous cryptococcosis mimicking molluscum contagiosum in a haemophiliac with AIDS . Clin Exp Dermatol. 1987;12:446-450.Crossref 24. Lynch DP, Naftolin LZ. Oral Cryptococcus neoformans infection in AIDS . Oral Surg Oral Med Oral Pathol. 1987;64:449-453.Crossref 25. Glick M, Cohen SG, Cheney RT, Crooks GW, Greenberg MS. Oral manifestations of disseminated Cryptococcus neoformans in a patient with acquired immunodeficiency syndrome . Oral Surg Oral Med Oral Pathol. 1987;64:454-459.Crossref 26. Lazareth I, Chanu B, Badillet G, Rybojad M, Dallot A, Rouffy J. Cryptococcose cutanée et viscérale chez un patient atteint d'un SIDA . Ann Dermatol Vernereol. 1987;114:1491-1493. 27. Ricciardi DD, Sepkowitz DV, Berkowitz LB, Bienenstock H, Malow M. Cryptococcal arthritis in a patient with acquired immune deficiency syndrome: case report and review of the literature . J Rheumatol. 1986;13:455-458. 28. Rico MJ, Penneys NS. Cutaneous cryptococcosis resembling molluscum contagiosum in a patient with AIDS . Arch Dermatol. 1985;121:901-902.Crossref 29. Borton LK, Wintroub BU. Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1984;10:387-390.Crossref 30. Baker RD, Haugen RK. Tissue changes and tissue diagnosis in cryptococcosis . Am J Clin Pathol. 1955;25:14-24. 31. Moore M. Cryptococcosis with cutaneous manifestations: four cases with a review of published reports . J Invest Dermatol. 1957;28:159-182. 32. Cawley EP, Grekin RH, Curtis AC. Torulosis: a review of the cutaneous and adjoining mucous membrane manifestations . J Invest Dermatol. 1950;14:327-341. 33. Saag MS, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal miningitis . N Engl J Med. 1992;326:83-89.Crossref 34. Murakawa GJ, Mauro TM, Egbert B. Disseminated cutaneous Cryptococcus clinically mimicking basal cell carcinoma . Dermatol Surg. 1995;21:992-993.Crossref 35. Sarosi GA, Nilberjarb PM, Tosh FE. Cutaneous cryptococcosis: a sentinel of disseminated disease . Arch Dermatol. 1971;104:1-3.Crossref 36. Powderly WG, Saag MS, Cloud GA, et al. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1992;326:793-798.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Cutaneous Cryptococcus Infection and AIDS: Report of 12 Cases and Review of the Literature

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890290079010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Cryptococcal infections occur in 6% to 13% of patients with acquired immunodeficiency syndrome (AIDS), most commonly infecting the central nervous system. Cutaneous lesions have been described morphologically as umbilicated papules, nodules, and violaceous plaques and can mimic molluscum contagiosum and Kaposi's sarcoma. Cutaneous lesions can present months prior to other signs of systemic infection. Observations: Cases of infection with cutaneous Cryptococcus and AIDS were reviewed and compared with cases reported in the literature. Among patients with Cryptococcus infection and AIDS seen at our institutions, 5.9% had skin lesions. All patients with cutaneous lesions had systemic involvement. Women were less commonly infected than men. There was no apparent predisposition associated with age, race, or human immunodeficiency virus infection risk factors. The median CD4 helper T-cell count was 0.024×109/L (24/ μL), and 44% (16/36) of the patients had previous opportunistic infections. Lesions were most commonly seen on the head and neck (78% [36/46]) and often mimicked molluscum contagiosum (54% [25/46]). The median serum and cerebrospinal fluid cryptococcal antigen titers were 1:32 768 and 1:512, respectively. Patients in our group did well with therapy (one death at 6 weeks, compared with 38% [13/34] mortality in the literature). There was no correlation between onset of lesions, number of lesions, CD4 helper T-cell count, or histopathologic characteristics. Conclusions: Disseminated Cryptococcus infection in AIDS presents with cutaneous lesions in up to 6% of cases. Clinicians need to be aware of the varied morphologic characteristics, since cutaneous lesions may present well in advance of other signs of systemic infection.(Arch Dermatol. 1996;132:545-548) References 1. Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis . Rev Infect Dis. 1991;13:1163-1169.Crossref 2. Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome . N Engl J Med. 1989;321:794-799.Crossref 3. Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated Cryptococcus . J Am Acad Dermatol. 1995;32:844-850.Crossref 4. Pema K, Diaz J, Guerra LG, Nabhan D, Verghese A. Disseminated cutaneous cryptococcosis: comparison of clinical manifestations in the pre-AIDS and AIDS era . Arch Intern Med. 1994;154:1032-1034.Crossref 5. Durden FM, Elewski B. Cutaneous involvement with Cryptococcus neoformans in AIDS . J Am Acad Dermatol. 1994;30:844-848.Crossref 6. Lui H, McLeod WA, Wood WS. An ulcerated plaque in a gay man . Arch Dermatol. 1993;129:495-500.Crossref 7. Blauvelt A, Kerdel FA. Cutaneous cryptococcosis mimicking Kaposi's sarcoma as the initial manifestation of disseminated disease . Int J Dermatol. 1992;31: 279-280.Crossref 8. Ghigliotti G, Carrega G, Farris A, et al. Cutaneous cryptococcosis resembling molluscum contagiosum in a homosexual man with AIDS . Acta Derm Venereol. 1992;72:182-184. 9. Manrique P, Mayo J, Alvarez JA, et al. Polymorphous cutaneous cryptococcosis: nodular, herpes-like, and molluscum-like lesions in a patient with the acquired immunodeficiency syndrome . J Am Acad Dermatol. 1992;26:122-124.Crossref 10. Cusini M, Cagliani P, Grimalt R, et al. Primary cutaneous cryptococcosis in a patient with the acquired immunodeficiency syndrome . Arch Dermatol. 1991; 127:1848-1849.Crossref 11. Ricchi E, Manfredi R, Scarani P, Costigliola P, Chiodo F. Cutaneous cryptococcosis and AIDS . J Am Acad Dermatol. 1991;25:335-336.Crossref 12. Shahab ST, Habte-Gabr E, Fedorko D. Significance of crypotococcal antigen titers in patients with AIDS . South Med J. 1991;84:1407-1408.Crossref 13. Poizot-Martin I, Grob JJ, Fournerie JR, et al. Cryotococcose cutanée à forme de molluscum contagiosum au cours du SIDA: un cas . Ann Dermatol Venereol. 1991;118:29-32. 14. Sofman MS, Heilman ER. Simultaneous occurrence of Kaposi's sarcoma and Cryptococcus within a cutaneous lesion in a patient with acquired immunodeficiency syndrome . Arch Dermatol. 1990;126:683-684.Crossref 15. Pierard, GE, Pierard-Franchimont C, Estrada JA, Rurangirwa A, Dosal FL. Cutaneous mixed infections in AIDS . Am J Dermatopathol. 1990;12:63-66.Crossref 16. Mares M, Sartori MT, Carretta M, Bertaggia A, Girolami A. Rhinaphyma-like cryptococcal infection as an early manifestation of AIDS in a hemophilia B patient . Acta Haematol. 1990;84:101-103.Crossref 17. Jones C, Orengo I, Rosen T, Ellner K. Cutaneous cryptococcosis simulating Kaposi's sarcoma in the acquired immunodeficiency syndrome . Cutis. 1990; 45:163-167. 18. Azon-Masoliver A, Gonzalez-Clemente J, Pedrol E, et al. Herpetiform and mollusca contagiosa-like cutaneous cryptococcosis in a patient with AIDS . Br J Dermatol. 1989;121:665-667.Crossref 19. Picon L, Vaillant L, Duong T, et al. Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS . Acta Derm Venereol. 1989; 69:365-367. 20. Miller SJ. Cutaneous Cryptococcus resembling molluscum contagiosum in a patient with acquired immunodeficiency syndrome . Cutis. 1988;41:411-412. 21. Concus AP, Helfand RF, Imber MJ, Lerner EA, Sharpe RJ. Cutaneous cryptoccosis mimicking molluscum contagiosum in a patient with AIDS . J Infect Dis. 1988;158:897-898.Crossref 22. Libow LF, Dobert D, Sibulkin D. Co-existent cutaneous cryptococcosis and Kaposi's sarcoma in a patient with the acquired immodeficiency syndrome . Cutis. 1988;41:159-162. 23. Jimenez-Acosta F, Casado M, Borbujo J, et al. Cutaneous cryptococcosis mimicking molluscum contagiosum in a haemophiliac with AIDS . Clin Exp Dermatol. 1987;12:446-450.Crossref 24. Lynch DP, Naftolin LZ. Oral Cryptococcus neoformans infection in AIDS . Oral Surg Oral Med Oral Pathol. 1987;64:449-453.Crossref 25. Glick M, Cohen SG, Cheney RT, Crooks GW, Greenberg MS. Oral manifestations of disseminated Cryptococcus neoformans in a patient with acquired immunodeficiency syndrome . Oral Surg Oral Med Oral Pathol. 1987;64:454-459.Crossref 26. Lazareth I, Chanu B, Badillet G, Rybojad M, Dallot A, Rouffy J. Cryptococcose cutanée et viscérale chez un patient atteint d'un SIDA . Ann Dermatol Vernereol. 1987;114:1491-1493. 27. Ricciardi DD, Sepkowitz DV, Berkowitz LB, Bienenstock H, Malow M. Cryptococcal arthritis in a patient with acquired immune deficiency syndrome: case report and review of the literature . J Rheumatol. 1986;13:455-458. 28. Rico MJ, Penneys NS. Cutaneous cryptococcosis resembling molluscum contagiosum in a patient with AIDS . Arch Dermatol. 1985;121:901-902.Crossref 29. Borton LK, Wintroub BU. Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome . J Am Acad Dermatol. 1984;10:387-390.Crossref 30. Baker RD, Haugen RK. Tissue changes and tissue diagnosis in cryptococcosis . Am J Clin Pathol. 1955;25:14-24. 31. Moore M. Cryptococcosis with cutaneous manifestations: four cases with a review of published reports . J Invest Dermatol. 1957;28:159-182. 32. Cawley EP, Grekin RH, Curtis AC. Torulosis: a review of the cutaneous and adjoining mucous membrane manifestations . J Invest Dermatol. 1950;14:327-341. 33. Saag MS, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal miningitis . N Engl J Med. 1992;326:83-89.Crossref 34. Murakawa GJ, Mauro TM, Egbert B. Disseminated cutaneous Cryptococcus clinically mimicking basal cell carcinoma . Dermatol Surg. 1995;21:992-993.Crossref 35. Sarosi GA, Nilberjarb PM, Tosh FE. Cutaneous cryptococcosis: a sentinel of disseminated disease . Arch Dermatol. 1971;104:1-3.Crossref 36. Powderly WG, Saag MS, Cloud GA, et al. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1992;326:793-798.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: May 1, 1996

References