Primary cutaneous cryptococcosis and secondary antigenemia in a patient with long-term corticosteroid therapy
We report a case of a 71-year-old male who developed severe cellulitis of his right forearm and hand after he had an accidental injury from the sharp edge of a metal plate of a birdhouse. The patient suffers from chronic asthma and has been treated with systemic corticosteroids for years. Culture of...
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Published in | Infection Vol. 33; no. 2; pp. 86 - 89 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Germany
Springer Nature B.V
01.04.2005
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Abstract | We report a case of a 71-year-old male who developed severe cellulitis of his right forearm and hand after he had an accidental injury from the sharp edge of a metal plate of a birdhouse. The patient suffers from chronic asthma and has been treated with systemic corticosteroids for years. Culture of aspirates from two sites of the wound area revealed growth of Cryptococcus neoformans in one and Acinetobacter lwoffii in the other. After combined treatment including antibiotics, antifungal therapy with fluconazole 400 mg/d and surgical debridement followed by a mesh graft, the patient achieved complete healing of the wound. Five months after the infection, the patient was still positive for cryptococcal antigen at a titer of 1:64 despite oral treatment with fluconazole 50 mg/d, and maintenance therapy with fluconazole 200 mg/d was recommended for 6 months, or longer depending on further results. The clinical and microbiological characteristics of this patient as well as therapeutical and epidemiological aspects of primary cutaneous cryptococcosis (PCC) are discussed. |
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AbstractList | We report a case of a 71-year-old male who developed severe cellulitis of his right forearm and hand after he had an accidental injury from the sharp edge of a metal plate of a birdhouse. The patient suffers from chronic asthma and has been treated with systemic corticosteroids for years. Culture of aspirates from two sites of the wound area revealed growth of Cryptococcus neoformans in one and Acinetobacter Iwoffii in the other. After combined treatment including antibiotics, antifungal therapy with fluconazole 400 mg/d and surgical debridement followed by a mesh graft, the patient achieved complete healing of the wound. Five months after the infection, the patient was still positive for cryptococcal antigen at a titer of 1:64 despite oral treatment with fluconazole 50 mg/d, and maintenance therapy with fluconazole 200 mg/d was recommended for 6 months, or longer depending on further results. The clinical and microbiological characteristics of this patient as well as therapeutical and epidemiological aspects of primary cutaneous cryptococcosis (PCC) are discussed. We report a case of a 71-year-old male who developed severe cellulitis of his right forearm and hand after he had an accidental injury from the sharp edge of a metal plate of a birdhouse. The patient suffers from chronic asthma and has been treated with systemic corticosteroids for years. Culture of aspirates from two sites of the wound area revealed growth of Cryptococcus neoformans in one and Acinetobacter lwoffii in the other. After combined treatment including antibiotics, antifungal therapy with fluconazole 400 mg/d and surgical debridement followed by a mesh graft, the patient achieved complete healing of the wound. Five months after the infection, the patient was still positive for cryptococcal antigen at a titer of 1:64 despite oral treatment with fluconazole 50 mg/d, and maintenance therapy with fluconazole 200 mg/d was recommended for 6 months, or longer depending on further results. The clinical and microbiological characteristics of this patient as well as therapeutical and epidemiological aspects of primary cutaneous cryptococcosis (PCC) are discussed. |
Author | Tintelnot, K Landthaler, M Szeimies, R-M Hafner, C Breindl, G Vogt, T Linde, H-J Koellner, K |
Author_xml | – sequence: 1 givenname: C surname: Hafner fullname: Hafner, C email: christian.hafner@klinik.uni-regensburg.de organization: Dept. of Dermatology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany. christian.hafner@klinik.uni-regensburg.de – sequence: 2 givenname: H-J surname: Linde fullname: Linde, H-J – sequence: 3 givenname: T surname: Vogt fullname: Vogt, T – sequence: 4 givenname: G surname: Breindl fullname: Breindl, G – sequence: 5 givenname: K surname: Tintelnot fullname: Tintelnot, K – sequence: 6 givenname: K surname: Koellner fullname: Koellner, K – sequence: 7 givenname: M surname: Landthaler fullname: Landthaler, M – sequence: 8 givenname: R-M surname: Szeimies fullname: Szeimies, R-M |
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SubjectTerms | Acinetobacter iwoffii Aged Antifungal Agents - therapeutic use Cryptococcosis - diagnosis Cryptococcosis - drug therapy Cryptococcosis - pathology Cryptococcus neoformans Dermatomycoses - drug therapy Dermatomycoses - microbiology Dermatomycoses - pathology Fluconazole - therapeutic use Glucocorticoids - adverse effects Humans Male Triamcinolone Acetonide - adverse effects |
Title | Primary cutaneous cryptococcosis and secondary antigenemia in a patient with long-term corticosteroid therapy |
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