Quéreux G, Milpied B, Morin O, Andrès P, Parant E, Poirier P, Rapp M J, Stalder J F
Clinique Dermatologique, Hôtel-Dieu, Nantes.
Ann Dermatol Venereol. 2001 Oct;128(10 Pt 1):1009-13.
Primary cutaneous cryptococcosis is an uncommon clinical entity characterized by direct skin inoculation without systemic involvement. We report four cases of this affection in HIV-negative patients seen between 1990 and 1999 in Nantes Dermatological Clinic.
Patients mean age was seventy. Three patients had recent exposure to soil or birds, and two remembered a trauma before the lesion appeared. In three cases the lesion was on the hand. In two cases the lesion was an ulcerated nodule, in another an abscess and in the last a cellulitis. Two subjects were treated by fludarabin and systemic corticosteroids for respectively chronic lymphocytic leukemia and Waldenstrom's macroglobulinemia. The third had a CD4 lymphopenia. Cultural examination confirmed the diagnosis. Treatment, with fluconazole in 3 cases and ketoconazole and itraconazole in 1 case, resulted in healing of the skin lesion in a few months.
Recognition of primary cutaneous cryptococcosis as a clinical entity has long been debated. An altered immunological status is an important factor for developing this disease. There is often a clear history of trauma or exposure to soil or birds preceding the development of the lesion. Clinically it often looks like a papule or an ulcerated nodule. The lesion is confined to the skin without systemic involvement. The prognosis is excellent thanks to the use of oral antifungal imidazoles.
原发性皮肤隐球菌病是一种不常见的临床病症，其特征为皮肤直接接种感染且无全身累及。我们报告了1990年至1999年期间在南特皮肤科诊所就诊的4例HIV阴性患者的这种疾病。
患者平均年龄为70岁。3例患者近期接触过土壤或鸟类，2例记得在皮损出现前有过外伤史。3例皮损位于手部。2例皮损为溃疡结节，另1例为脓肿，最后1例为蜂窝织炎。2名患者分别因慢性淋巴细胞白血病和华氏巨球蛋白血症接受氟达拉滨和全身用皮质类固醇治疗。第3例患者存在CD4淋巴细胞减少。培养检查确诊了诊断。3例患者用氟康唑治疗，1例用酮康唑和伊曲康唑治疗，皮损在数月内愈合。
原发性皮肤隐球菌病作为一种临床病症的认识长期以来一直存在争议。免疫状态改变是发生这种疾病的一个重要因素。在皮损出现之前，往往有明确的外伤史或接触土壤或鸟类的历史。临床上它常表现为丘疹或溃疡结节。皮损局限于皮肤，无全身累及。由于使用口服抗真菌咪唑类药物，预后良好。
