Cutaneous Manifestation of Disseminated Cryptococcosis Mimicking Herpes Zoster

Abstract

Cutaneous cryptococcosis is classified either as localized cutaneous cryptococcosis, in which the lesions are confined to one area of the skin, or as disseminated cryptococcosis, in which cutaneous manifestations are more widespread. We report a case of fatal disseminated cryptococcosis with characteristic cutaneous manifestations. An 84-year-old woman with diabetes presented with crusted plaques and ulcers that were painful, diffuse, and erythematous to crusted and on only the left side of her face, neck, and upper chest. She was referred to our hospital from a local clinic, where herpes zoster had been suspected. She had no specific systemic symptoms. Histological examination of the skin lesion revealed granulomatous reactions and purple to reddish encapsulated spores. Cryptococcus neoformans was identified in fungal culture, and hospitalization was recommended. Oral fluconazole was prescribed, and she was admitted to another hospital. After 2 weeks, the patient's condition deteriorated, and she was transferred to our hospital. C. neoformans antigen was detected in the blood and urine during the evaluation for systemic involvement. The patient was treated with intravenous amphotericin B and fluconazole; however, she died 10 days after admission. Cutaneous manifestations of disseminated cryptococcosis can appear in various forms and mimic molluscum contagiosum, Kaposi's sarcoma, and cellulitis. In this case, the skin lesions occurred on only the left side of the face, neck, and chest, as in herpes zoster. Cutaneous cryptococcosis can occur before the onset of symptoms of systemic involvement; therefore, diagnosis is important. Systemic evaluation may reveal early markers of disseminated cryptococcosis.