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Disseminated Cryptococcosis with Cutaneous Manifestations—Report of Two Cases—
Chia-Chen Wang Chien-Hsun Chen I-Hsin Shih Heng-Leong Chan
Dermatol Sinica 20: 38-45, 2002

Disseminated cryptococcosis occurs mainly in immunocompromised hosts and has cutaneous involvement occuring in 10-20 % of cases. However, cryptococcal skin lesions have no unique or identifying features that alert one to the correct diagnosis. The mortality rate of disseminated cryptococ-cosis is 70-80 % and it can be reduced to 10-20 % with prompt diagnosis and treatment. We report two cases of disseminated cryptococcosis with cutaneous manifestations. One was a recipient of renal trans-plant who developed cryptococcal meningitis and was initially treated with fluconazole. Pulmonary and cutaneous cryptococcosis mimicking erythema nodosum relapsed one month after initial remission and were subsequently cured with amphotericin B followed by fluconazole consolidation therapy. The second patient, who had a history of diabetes mellitus and received prolonged broad spectrum antibiotics for multiple infections, presented with multiple subcutaneous nodules and vasculitis as the manifestations of cryptococcosis and expired due to multi-organ failures even after amphotericin B therapy. In conclusion, cryptococcosis should be considered as a differential diagnosis in immunocompromised patients with any cutaneous lesions. Although fluconazole is less nephrotoxic, amphotericin B remains the mainstay of therapy in immunocompromised patients.

   
   
 
 
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