Disseminated Cryptococcosis presenting as cellulitis in a renal transplant recipient.

Jan 2013

Chaya R, Padmanabhan S, Anandaswamy V, Moin A.

Source

Apollo BGS Hospitals, Mysore, Karnataka, India. drchayadr17@yahoo.com.

Abstract

Cellulitis is an unusual presentation of  renal transplant  in renal allograft recipients. In such patients, disseminated cryptococcal infection can result in significant morbidity and mortality. Patients are often treated with antibiotics before a definitive diagnosis is made, delaying appropriate therapy. We describe the case of a 43-year-old post renal transplant recipient presenting with fever and swelling in the right thigh. On physical examination, the patient was found to have features suggestive of cellulitis with minimal slurring of speech. Material obtained from incision and drainage of the wound showed yeast cells resembling Cryptococcus spp. Blood culture and cerebrospinal fluid culture were also found to have growth of Cryptococcus neoformans. He received treatment with amphotericin B 6 mg/kg daily intravenously for two weeks, then continued with fluconazole 400 mg daily for three months. The patient showed a remarkable improvement. There was no recurrence of cryptococcosis after four months of follow-up. The diagnosis of disseminated cryptococcosis should be considered in differential diagnosis of cellulitis among non HIV immunocompromised hosts. A high clinical suspicion and early initiation of therapy is needed to recognize and treat patients effectively.

JIDC

Cellulitis revealing a cryptococcosis-related immune reconstitution inflammatory syndrome in a renal allograft recipient.

Cellulitis revealing a cryptococcosis-related immune reconstitution inflammatory syndrome in a renal allograft recipient.
Am J Transplant. 2007 Dec

Lanternier F, Chandesris MO, Poirée S, Bougnoux ME, Mechai F, Mamzer-Bruneel MF, Viard JP, Galmiche-Rolland L, Lecuit M, Lortholary O.

Service des Maladies Infectieuses et Tropicales Hôpital Necker-Enfants Malades, Université Paris V Centre d'Infectiologie Necker-Pasteur, Paris, Cedex 15, France.

Corresponding author: Olivier Lortholary, olivier.lortholary@nck.aphp.fr

Immune reconstitution inflammatory syndrome (IRIS) has rarely been described in the course of disseminated cryptococcosis in solid organ transplant recipients. We report here the case of a renal transplant recipient who developed severe cellulitis in the context of Cryptococcus neoformans-associated IRIS while undergoing reduction of his immunosuppressive therapy. IRIS appeared concomitantly with a dramatic increase of blood CD4+ T cells (94-460/mm(3)) and required the administration of a short-term steroid therapy to resolve.

Blackwell Synergy

Disseminated cryptococcosis initially presenting as cellulitis in a rheumatoid arthritis patient

Disseminated cryptococcosis initially presenting as cellulitis in a rheumatoid arthritis patient

J Chin Med Assoc. 2007 Jun
Lu HC, Yang YY, Huang YL, Chen TL, Chuang CL, Lee FY, Lee SD.
Department of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Key Words: cellulitis, Cryptococcus neoformans, rheumatoid arthritis

Infection with Cryptococcus neoformans often occurs in immunocompromised hosts. It is usually acquired by invasion of the respiratory tract, and then the organisms may spread hematogenously to other viscera, mainly the central nervous system. Although there are some reports of primary cutaneous cryptococcosis, cryptococcal skin disease is a rare feature of disseminated cryptococcosis, and has a poor outcome if unrecognized and untreated. We present a case of cryptococcal cellulitis in a patient with rheumatoid arthritis who was receiving long-term steroid treatment.

Reviewing the literature, this is the first report of rheumatoid arthritis with disseminated cryptococcosis initially presenting as cellulitis.

Elsevier