Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS

A 30-year-old homosexual man developed multiple skin umbilicated lesions resembling molluscum contagiosum. Initially the lesions were on his face but they rapidly spread. Histopathology and mycologic cultures of a skin biopsy revealed cryptococcus neoformans which was also identified in cerebrospinal fluid and in bronchoalveolar washings. The patient had fever, weight loss, generalized lymph node enlargement, depletion of the T helper subpopulation and positive HIV-1 serology. During treatment with flucytosine and amphotericin B, the skin lesions regressed in 3 months (cryptococcus neoformans disappeared in the cerebrospinal fluid and skin within one and five weeks, respectively). Our case demonstrates that molluscum contagiosum-like skin manifestations may be caused by cryptococcal infections. So it is necessary to perform skin biopsy in HIV seropositive patients with skin lesions resembling molluscum contagiosum, to diagnose mycotic infections, and especially cryptococcosis. Cutaneous cryptococcosis was, in this case, the first symptom of AIDS.     

Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D

We report a Healthy, 73-year-old Japanese woman who presented with primary cryptococcosis on the skin of both cheeks. She had initially developed an erythematous, partly ulcerated lesion on the right cheek 2 weeks earlier following an injury. There was no regional lymphadenopathy, and chest X-rays were normal. Histopathological findings showed granulomatous cell infiltration, Periodic acid Schiff staining revealed spores that were identified by the indirect immunoperoxidase staining method as Cryptococcus neoformans. The isolate was identified as C. neoformans var. neofarmans serotype D. The skin lesions healed in 1 month without antifungal therapy. A literature review indicates that this serotype tends to produce cutaneous lesions without systemic involvement.     

Cutaneous cryptococcal infection presenting as vulvar lesion.

A woman aged 60, who had been immunosuppressed since receiving a renal transplant 17 years before, developed a painless ulcerated lesion on her right labia majora. Cryptococcus neoformans was demonstrated by culture and biopsy of the lesion. This is the first reported case of a genital skin lesion caused by C neoformans.     

新生隐球菌28S rDNA的基因型特征与序列分析

目的 探讨新生隐球菌各变种、血清型与基因型的关系。方法 新生隐球菌标准株10株、新生隐球菌荚膜缺陷株CAP10以及临床分离株19株,采用变性梯度胶电泳(DGGE)结合DNA序列分析,对以上菌株的28S rDNA片段进行研究。结果 经过DGGE和DNA序列分析,所有新生隐球菌新生变种(A、D型)具有一致的基因带型和序列,格特变种(B、C型)具有不同于新生变种的独特一致的带型和序列;AD型的基因型和序列与格特变种完全相同,新生隐球菌荚膜缺陷株CAP10(D型)的基因型类同于新生变种;19株临床分离菌在DGGE上可分为2型,17株与A、D型完全相同,2株与B、C型相同。结论 DGGE结合DNA序列分析,对于探讨新生隐球菌各变种、血清型的基因型特征、关系具有重要价值;我国非艾滋病隐球菌病感染以新生变种为主,AD型在系统发育上更类同于格特变种,而不是新生变种;本研究不支持A血清型为新生变种以外的新变种即grubii变种的观点。     

Cryptococcal Granulomata of the Skin in a Patient with Pulmonary and Cerebral Cryptococcosis

A case of pulmonary granuloma due to Cryptococcus neoformans is reported. Focal cryptococcal granulomata developed over the facial skin and death followed the development of cryptococcal meningitis.     

荚膜在小鼠原发性皮肤新生隐球菌感染中的作用

目的探讨新生隐球菌多糖荚膜在小鼠原发性皮肤新生隐球菌感染中的作用。方法按照笔者建立的原发性皮肤隐球菌感染模型构建方法,将新生隐球菌标准野生株B3501与荚膜缺陷株cap64分别皮内接种于免疫抑制与非抑制的BALB/c小鼠,皮损真菌培养与组织病理检查确证感染。观察2种隐球菌感染的病程,比较皮损形成与消退的时间。结果野生株与荚膜缺陷株新生隐球菌皮下接种于BALB/c小鼠后,均可以在免疫抑制与非抑制的BALB/c小鼠皮肤上产生结节、丘疹、溃疡、传染性软疣样皮损,皮损可以自愈,真菌培养与病理确证为隐球菌感染。2种菌株感染的病程差异无显著性意义。结论野生株与荚膜缺陷株新生隐球菌均可以造成BALB/c小鼠相似的皮肤感染。荚膜可能不是小鼠皮肤隐球菌感染的主要毒力因子。     

隐球菌与体外培养角质形成细胞的相互作用

目的：研究隐球菌与体外培养的角质形成细胞的相互作用。方法：检测新生隐球菌对体外培养的角质形成细胞HaCaT株（简称HaCaT细胞）的时间-浓度黏附率、通透率;检测新生隐球菌对细胞的损伤;透射电镜观察二者相互作用的超微结构。结果：新生隐球菌标准野生株B3501（简称B3501）可以对HaCaT细胞产生黏附与侵袭,黏附率与侵袭率呈现时间依赖性;同时,B3501还可以使HacaT细胞凋亡率升高,对其造成损伤,这与菌体的活力相关。超微结构可见新生隐球菌与角质形成细胞的黏附与侵袭过程。结论：活的隐球菌黏附与侵袭角质形成细胞是其感染皮肤的重要条件。进一步明确二者的相互作用对隐球菌发病机制的研究具有重要意义。     

皮肤隐球菌病1例

报告1例皮肤隐球菌病。患儿男，12岁。因肾病综合征给予大剂量甲泼尼龙及环磷酰胺冲击治疗，面部及前臂出现多发性传染性软疣样皮疹，真菌学和组织病理检查证实为皮肤隐球菌病，给予氟康唑治疗无效，患者9d后死于急性肾功能衰竭。     

Preceding Annular Skin Lesions in a Patient with Hemophagocytic Lymphohistiocytosis

The cutaneous manifestations of hemophagocytic lymphohistiocytosis (HLH) are variable and nonspecific. A 42-year-old man presented with multiple annular, erythematous patches on the trunk for 3 months. Two months later, he presented with bullae along with high fever. The laboratory examination showed pancytopenia, hypertriglyceridemia, and hypofibrinogenemia. The bone marrow biopsy specimen showed an active hemophagocytosis. On the basis of these findings, a diagnosis of HLH was concluded. After five cycles of chemotherapy, his skin lesion completely resolved. Taking the results together, we suggest that annular skin lesion can be added to the list of cutaneous manifestations of HLH.     

Primary cutaneous cryptococcosis in a patient with systemic immunosuppression after liver transplantation

We report a 36-year-old woman who slowly developed an ulceration on the left thigh 2 years after transplantation for Budd-Chiari syndrome. At this time point, the patient was treated with prednisone, tacrolimus and azathioprine for immunosuppression and with phenprocoumon and low-dose aspirin for anticoagulation in the presence of polycythemia vera. A biopsy of the skin lesion was obtained and revealed encapsulated yeast that was identified by microbiological and serological methods as Cryptococcus neoformans serotype D. The patient had no signs of systemic infection and a therapy with fluconazole (200 mg/day) was started. The lesion healed within 8 weeks and fluconazole was stopped after 3 months. Due to interactions between fluconazole, tacrolimus and phenprocoumon, the latter drugs were decreased to prevent toxicity. So far, 1 month after stopping fluconazole, no recurrence of skin lesions has been observed.     

艾滋病并发播散性皮肤隐球菌病

报告1例艾滋病并发播散性皮肤隐球菌病。患者女,32岁。人免疫缺陷病毒(HIV)抗体阳性,无系统感染症状,皮损表现为传染性软疣样。皮损组织病理示组织细胞内外可见大量有荚膜的孢子,PAS染色阳性。皮损真菌培养阳性,菌种鉴定为新生隐球菌。治疗给予氟康唑静脉滴注,半个月后原有皮损结痂愈合,但右背部又新发带状疱疹。     

Langerhans Cell Histiocytosis Masquerading as Lichen Aureus

We report a 13-year-old boy with localized Langerhans cell histiocytosis. The lesion was restricted to the skin of the mons pubis and clinically resembled lichen aureus. Histopathologic and electron microscopic examinations of a skin biopsy specimen of the lesion showed typical features of Langerhans cell histiocytosis. Extensive examination revealed no other organ involvement.     

Atrophic dermatofibroma and dermatofibrosarcoma protuberans

Dermatofibroma and dermatofibrosarcoma protuberans usually are seen as firm nodules in the skin. We have observed several patients, all female, with an atrophic or depressed lesion on the chest or back. When biopsy was done, the biopsy punch was often noted to sink into the lesion. In each case the biopsy specimen showed a cellular dermatofibroma or dermatofibrosarcoma protuberans. The correct diagnosis was rarely suspected clinically. This uncommon clinical presentation may be related to the marked cellularity of the fibrous tumors in this series.     

Congenital Smooth Muscle Hamartoma of the Skin

Abstract: : A 2-month-old white girl had a congenital, tan-colored, slightly elevated, 3 × 2-cm plaque on the left midback. Clinically, the lesion was suspected to be a solitary masiocytoma. Rubbing the lesion produced a transient erythema and edema that was similar to Darier sign seen in mastocytoma. Analysis of a skin biopsy specimen revealed a smooth muscle hamartoma; special stains did not show evidence of increased numbers of mast cells. This relatively uncommon condition can be confused with a variety of other cutaneous diseases. Light microscopic examination of a skin biopsy specimen establishes the diagnosis. A review of the approximately 50 cases reported in the literature showed that there is no known associated systemic involvement or malignant transformation. The clinical lesions usually become less prominent with time.     

Multiple eccrine spiradenomas in zosteriform distribution in a child

A 9-year-old boy presented with asymptomatic papulonodular lesions on the left half of the chin of 3-years duration. On examination he had small papular lesions on the left chin varying in size from 1 to 5 mm. An additional lesion on the margin of the lip was 14 mm in diameter. The overlying skin was normal. Lesions were firm, nontender, and fixed to the skin. Histopathologic examination of the biopsy specimen revealed characteristic features of eccrine spiradenoma. A literature search produced reports of 10 cases of linear/zosteriform spiradenoma. Of these, five were in children or adolescents. We report this patient because of the rare occurrence of this presentation.     

Granulocytic sarcoma presenting as a solitary nodule of skin in a patient with Waldenstrom's macroglobulinemia. An immunohistochemical and electron-microscopic study

While he was being treated for Waldenstrom's macroglobulinemia, a 75-year-old man developed an enlarging forearm skin nodule. On biopsy, the lesion appeared to be a malignant lymphoma. The tumor cells were negative for immunoglobulins but positive for lysozyme and alpha-1-antitrypsin. Therefore, the lesion was diagnosed as histiocytic lymphoma. Nine months later, an ipsilateral axillary lymph node biopsy revealed a small focus of tumor identical to that of the skin lesion. Three months after the lymph node biopsy, the patient developed acute myeloid leukemia. A reevaluation of the electron micrographs of the skin and lymph node lesion showed primary lysosomal granules within the tumor cell cytoplasm consistent with a diagnosis of leukemic infiltrates (granulocytic sarcoma); additionally, the naphthol AS-D chloracetate esterase activity of the skin lesion was positive, supporting the diagnosis of granulocytic sarcoma. This report shows that if not suspected, granulocytic sarcoma is difficult to diagnose in nonleukemia patients.     

Persistent cellulitis in a patient receiving renal dialysis

Cryptococcus neoformans, an opportunistic fungus, may cause cutaneous disease by dissemination from primary lung infection or, more rarely, by direct cutaneous inoculation. Cellulitis in an immunocompromised host who does not respond to conventional antibacterial therapy should alert the physician to consider other diagnoses, including cryptococcal skin infection.     

Cutaneous infection by Mycobacterium fortuitum biovariant "third group"--a case report and bacteriological examination of the isolate

A 22-year-old woman with ten-year history of atopic dermatitis first noticed an erythematous ++, indurated, and fluctuant lesion on her back six month prior to visiting our hospital in February 1989. The dusky red skin lesion gradually spread to the right side of her trunk and drained small amount of purulent or serosanguineous fluid. A skin biopsy specimen showed mixed pattern of nonspecific inflammatory infiltrate and granulomatous infiltrate in the dermis. A culture of the biopsy specimen showed a rapidly growing atypical acid-fast bacteria, which was identified as Mycobacterium fortuitum and classified as biovariant "third group" by positive growth on mannitol and inositol. Minimum inhibitory concentrations (MICs) of different antimicrobial agent using broth medium showed that the isolate was susceptible to the new quinolones such as ofloxacin and ciprofloxacin. The patient responded to treatment with doxycycline followed by with ofloxacin. Subspecies classification and antibiotic susceptibilities were discussed with special reference to treatment of rapidly growing mycobacteria.     

Cryptococcosis during systemic glucocorticosteroid treatment

Cryptococcosis is an opportunistic infection caused by a fungus, Cryptococcus neoformans. It is usually seen in immunocompromised patients with AIDS, leukaemia, lymphoma, sarcoidosis or immunosuppressive treatments. We describe a patient who was treated with systemic glucocorticosteroids for 4 years because of lung sarcoidosis. During the last year of treatment, a papular eruption developed which later became ulcerative. In a histopathological examination of a skin biopsy, there was granulomatous inflammation, and the disease was treated as sarcoidosis without success. After 1 year's unsuccessful treatment, another skin biopsy and skin fungal culture revealed C. neoformans. Cryptococcal antigen was found in blood and cerebrospinal fluid, too. The patient was successfully treated first with an amphotericin-B-flucytosine combination and later with fluconazole.