Purpose of the study: To report the results of clinical and laboratory investigations concerning a patient with disseminated cryptococcosis and presenting with multiple cutaneous lesions and osteomyelitis. Clinical and Laboratory Studies: A 33-year-old female was admitted to the hospital with multiple nodules and ulcers on her upper arms, shoulders, buttocks and thigh which had persisted for one year. Four months prior to this admission, she gave birth to a premature boy. Two weeks after her delivery, she developed additional, new lesions. Five years ago, she presented with fever, cough and blood in the sputum, was diagnosed with tuberculosis, and cured by anti-tuberculosis treatment. Before her most recent admission, she was suspected to have blood source disseminated pulmonary tuberculosis and was given anti-tubercle therapy for three months but therapy failed. Physical examination revealed 39 nodules or ulcers on the face, gum, trunk, buttocks and extremities. The bone structure of the left tibia and fibula was destroyed and a sinus developed on the left fibula. Microbiology examination showed an abundance of yeasts in the smears of pus from necrotic tissues. Culture of pus produced yeast-like colonies and isolates gave positive urease and caffeic acid tests. The organisms were identified as Cryptococcus neoformans, serotype A. Results and conclusions: This patient was diagnosed with disseminated cutaneous cryptococcosis and osteomyelitis. Anti-tubercular therapy was immediately terminated and anti-fungal drug treatment was initiated. The patient received intravenous and topical amphotericin B (50mg/d for 76 days) in combination with fluconazole (400mg/d for 101 days) in initial therapy and itraconazole (200mg/d for 178 days) in maintenance therapy. The nodules disappeared in 30 days and the last ulcer in the left tibia was healed completely in 200 days. Antifungal therapy was discontinued on day 277. The patient was completely cured and regained her normal lifestyle. Dissemination of disease was most probably the result of immunosuppression caused by anti-tuberculosis drugs, anemia during pregnancy, and, more importantly, labor that promoted the pathogen’s systemic hematogenous dissemination.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)