Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Case Letter
doi: 10.4103/0378-6323.164216
PMID: 26345652

Disseminated cryptococcosis

Ying Yang, Yong-nian Shen, Wen-kai Zong, Pan-gen Cui
 Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, 210042, China

Correspondence Address:
Pan-gen Cui
Jiangwangmiao Street No. 12, Nanjing, Jiangsu, 210042
Wen-kai Zong
Jiangwangmiao Street No. 12, Nanjing, Jiangsu, 210042
How to cite this article:
Yang Y, Shen Yn, Zong Wk, Cui Pg. Disseminated cryptococcosis. Indian J Dermatol Venereol Leprol 2016;82:206-208
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology


Cryptococcosis is mainly caused by two species of Cryptococcus that is, C. neoformans and C. gattii. Disseminated cryptococcosis is defined by a positive culture from at least two different sites or a positive blood culture. [1] We report a case with manifestations in lung and skin, with positive cultures from both sites identified as of the same fungus by DNA sequencing.

A 33-year-old male presented with a 3-month history of a nodule on the left upper eyelid and a 2-month history of productive cough. The nodule had enlarged gradually, after the onset of cough. There was no history suggestive of tuberculosis, acquired immunodeficiency syndrome (AIDS), idiopathic T-cell lymphopenia, diabetes mellitus, autoimmune disease, glucocorticoid use, high risk behavior or trauma. None of the family members had similar manifestations. Cutaneous examination revealed a dark red nodular plaque of size 1.5 cm × 1.0 cm with crusting, on the left upper eyelid [Figure - 1].

Figure 1: A 1.5 × 1.0 cm dark red nodular plaque with hemorrhagic crusting on the left upper eyelid

Laboratory studies including a complete blood count, urinalysis and blood biochemistry were normal; blood and sputum cultures were negative. HIV screening was also negative. T-cell subset counts were not done. Histopathologic examination [Figure - 2]a of the cutaneous lesion revealed numerous yeast cells in the dermis which stained positive with periodic acid-Schiff (PAS) [Figure - 2]b and mucicarmine [Figure - 2]c. Fungal culture [Figure - 3] of the skin lesion yielded milky colonies in Sabouraud′s dextrose agar (SDA) medium. Mycological examination of the culture with India ink [Figure - 4] was positive. Computed tomography (CT) of the chest revealed cavitary lesions in the left lung [Figure - 5]. A fiber bronchoscopic biopsy was then done, and this revealed plenty of round organisms which stained positive with PAS and PAM (periodic acid-silver methenamine), suggestive of cryptococcus. Cryptococcus was also cultured from bronchoalveolar lavage fluid. Cerebrospinal fluid examination and a CT scan of the head were carried out, and both were normal. C. neoformans was identified in culture from both the skin and lung by multi-locus sequence typing, confirming disseminated cryptococcosis.

Figure 2: (a) Numerous yeast cells in the dermis (H and E, ×100). (b) Yeast cells stained purple with PAS (×100) and (c) pink with mucicarmine (×100)
Figure 3: Growth of milky colonies in SDA medium
Figure 4: India ink preparation showing gemmulate spores typical of Cryptococcus
Figure 5: CT scan of the chest showing multiple cavitary lesions in the left lung

Risk factors for disseminated cryptococcosis include immunosuppression, malignancy, corticosteroid therapy, diabetes, and connective tissue disease. [2] None of these was present in our case, but he was a garbage collector and there might have been occupational exposure to Cryptococcus via soil, dust, sticks, or bird feces. Moreover, some case reports have reported disseminated cryptococcosis in immunocompetent patient. [3],[4] Manifestations of cutaneous cryptococcosis are varied. Lesions may resemble molluscum contagiosum, or appear acneiform, nodular, herpetiform, cellulitic, or keloid-like. [5]

The management of cryptococcosis is not well-defined. Amphotericin B with or without flucytosine was considered the standard treatment in patients with disseminated cryptococcosis. [6] Fluconazole has been reported to be the most utilized treatment for cutaneous cryptococcosis, with a 600 mg daily dose for 40-60 days. [5] One report describes four pulmonary cryptococcosis patients initially treated with amphotericin B developing adverse reactions to it, and oral fluconazole then being used (600 mg daily for 4-5 weeks, followed by 400 mg daily for 10-12 weeks). [7] Non-central nervous system infection in HIV patients can also be treated with oral fluconazole 200-400 mg daily. If fluconazole is not tolerated, itraconazole 200-400 mg daily for 6-12 months may be used. [8] Our patient was treated with itraconazole 200 mg daily, after he failed to respond to fluconazole, 150 mg daily for 12 days, 800 mg daily for 1 day, followed by 400 mg daily for 10 days. Response to itraconazole was evident, with the skin nodule clearing, the cough improving and the lung cavitary lesions found to have shrunk on a follow-up CT scan after 20 days of treatment. Unfortunately, he discharged himself against medical advice and was lost to follow up. This case suggests that itraconazole might be a good option for patients with lung and cutaneous involvement in C. neoformans infection.


Special thanks to MIN LI M.D. and Ph.D. (Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College).

Chuang YM, Ho YC, Chang HT, Yu CJ, Yang PC, Hsueh PR. Disseminated cryptococcosis in HIV-uninfected patients. Eur J Clin Microbiol Infect Dis 2008;27:307-10.
[Google Scholar]
Lee JJ, Hsia RY. Cutaneous cryptococcal infection as a manifestation of disseminated disease. Cryptococcus neoformans. Ann Emerg Med 2011;57:100, 103.
[Google Scholar]
Suchitha S, Sheeladevi CS, Sunila R , Manjunath GV. Disseminated cryptococcosis in an immunocompetent patient: A case report. Case Rep Pathol. Avalilable at: Accessed February 28, 2012.
[Google Scholar]
Godbole R, Nayar P, Pradhan A, Manchanda R. Disseminated cryptococcosis in an immunocompetent child. Indian J. Hematol. Blood Transfus 2007;23:122-24.
[Google Scholar]
Lortholary O, Nunez H, Brauner MW, Dromer F. Pulmonary cryptococcosis. Semin. Repir. Crit. Care Med. 2004;25:145-57.
[Google Scholar]
Nasser N, Nasser FN, Vieira AG. Primay cutaneous cryptococcosis in an immunocompetent patient. An Bras Dermatol 2011;86:1178-80.
[Google Scholar]
Nunez M, Peacock JE Jr, Chin R Jr. Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: A report of four cases and a review of the literature. Chest 2000;118:527-34.
[Google Scholar]
Mehrabi M, Bagheri S, Leonard MJ, Perciaccante VJ. Mucocutaneous manifestation of cryptococcal infection: Report of a case and review of the literature. J Oral Maxillofac Surg 2005;63:1543-9.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections