Primary Cryptococcal Cellulitis in an Immunocompetent Individual via Traumatic Inoculation
Abstract:
Background: Cryptococcus gattii is a pathogenic fungus that poses a significant threat to immunocompromised populations, with the most classic presentation being life-threatening CNS disease such as meningitis. Cryptococcosis in immunocompetent individuals is usually asymptomatic or results in mild illness. We present the case of a 77-year-old immunocompetent male with severe necrotizing cellulitis found to be a rare primary presentation of Cryptococcus gattii.
Case report: A 77-year-old male with a past medical history significant for chronic kidney disease presented to the emergency room for evaluation of progressive left-hand cellulitis that had been developing for 10 days. He had no history of immunocompromise and no central nervous system complaints. The patient noticed an unexplained, small lesion on the dorsum of his left hand followed by progressive swelling over the next day for which he was treated with empiric antibiotics. The condition progressed despite daily oral antibiotics and he was hospitalized as the cellulitis had worsened significantly with evidence of hemorrhagic bulla and swelling of his entire extremity. The wound was debrided surgically with intraoperative cultures yielding Cryptococcus gattii. The patient was treated with antifungal medication, multiple debridements, and skin grafting.
Conclusions: Serious cryptococcal infection in immunocompetent hosts remains a rare presentation. Cryptococcal cellulitis, a rare manifestation in its own right, is sometimes a manifestation of disseminated cryptococcal disease found in immunocompromised individuals. This report supports new thought that Cryptococcus gattii may be more virulent and pathogenic in immunocompetent individuals than Cryptococcus neoformans. Clinicians should rule out underlying immunocompromise in the setting of confirmed cryptococcal cellulitis
