Abstract • Five patients with disseminated cryptococcosis had lesions on the extremities resembling cellulitis, which evolved into areas of blistering and ulceration in three patients. All had underlying disease and were medically immunosuppressed. Disseminated cryptococcosis appears to present with cellulitis or herpes-like vesiculation more commonly than is currently appreciated. India ink preparations of aspirates from areas of cellulitis or Tzanck preparations from blisters may show characteristic organisms, and makes possible an immediate diagnosis of cutaneous cryptococcosis. If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy. With increasing awareness of cutaneous involvement, some cases of disseminated cryptococcosis will be diagnosed sooner, leading to earlier therapy and improved prognosis. (Arch Dermatol 112:1734-1740, 1976) References 1. Littman ML, Zimmerman LE: Cryptococcosis: Torulosis . New York: Grune & Stratton, Inc, 1956. 2. Littman ML, Walter JE: Cryptococcosis: Current status . Am J Med 45:922-932, 1968.Crossref 3. Shome SK, Sirkar DK, Gunani HC: Changing spectrum of cryptococcosis in Delhi . Indian J Med Res 61:23-29, 1973. 4. Spickard A: Diagnosis and treatment of cryptococcal disease . South Med J 66:26-31, 1973.Crossref 5. Rippon JW: Medical Mycology . Philadelphia: WB Saunders Co, 1974, pp 218-222. 6. Kaufman L: Sero diagnosis of fungal disease , in Lennett EH, Spaulding EH, Truant JP (eds): Manual of Clinical Microbiology , ed 2. Washington, DC: American Society of Microbiology, 1974, pp 557-568. 7. Bushke A: Ueber eine durch coccidien hervorgerufen Krankheit des Menschen . Deutsche Med Wschr 21:14, 1895.Crossref 8. Littman ML, Schneierson SS: Cryptococcosis neoformans in pigeon excreta in New York City . Am J Hyg 69:49-59, 1959. 9. Moore M: Cryptococcosis with cutaneous manifestations . J Invest Dermatol 28:159-182, 1957. 10. Procknon JJ, et al: Cryptococcal hepatitis presenting as a surgical emergency . JAMA 191:269-274, 1965.Crossref 11. Balasubramaniam P, Silva JF: Case of cryptotoccosis of spine . Br Med J 2:27-28, 1973.Crossref 12. Tillotson JF, Lerner AM: Prostatism in an 18-year-old boy due to infection with Cryptococcal neoformans . N Engl J Med 273:1150-1152, 1965.Crossref 13. Randall RE Jr, et al: Cryptococcal pyelonephritis . N Engl J Med 279:60-65, 1968.Crossref 14. Watson NE Jr, Johnson AH: Cryptococcal peritonitis . South Med J 66:387-388, 1973.Crossref 15. Crounse RG, Lerner AB: Cryptococcosis: Case with unusual skin lesions and favorable response to amphotericin B therapy . Arch Dermatol 77:210-215, 1958.Crossref 16. Rook A, Woods B: Cutaneous cryptococcosis . Br J Dermatol 74:43-49, 1962.Crossref 17. Braverman IM: Skin Signs of Systemic Diseases . Philadelphia: WB Saunders Co, 1970, p 131. 18. Sarosi GA, Silberfarb PH, Tosh FE: Cutaneous cryptococcosis: A sentinel of disseminate disease . Arch Dermatol 104:103, 1971.Crossref 19. Noble RC, Fajardo LF: Primary cutaneous cryptococcosis: Review and morphological study . Am J Clin Pathol 57:13-22, 1972.
Archives of Dermatology – American Medical Association
Published: Dec 1, 1976