Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.
BMC Infect Dis. 2010 Aug 11;10:239. doi: 10.1186/1471-2334-10-239.
Cryptococcus neoformans is an encapsulated yeast and the most frequent cryptococcal species found in humans. Cryptococcosis is considered an opportunistic infection as it affects mainly immunosuppressed individuals. In humans, C. neoformans causes three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and wound or cutaneous cryptococcosis.
An 81-year-old woman developed severe necrotizing cellulitis on her left arm without any preceding injury. The patient had been treated with systemic corticosteroids over twenty years for rheumatoid arthritis (RA). Skin biopsies of the wound area were initially interpreted as cutaneous vasculitis of unknown etiology. However, periodic acid Schiff staining and smear analysis later revealed structures consistent with Cryptococcus neoformans, and the infection was subsequently confirmed by culture. After the initiation of therapy with fluconazole 400 mg per day the general condition and the skin ulcers improved rapidly and the patient was discharged to a rehabilitation facility. Subsequently surgical debridement and skin grafting were performed.
Opportunistic infections such as cryptococcosis can clinically and histologically mimic cutaneous vasculitis and have to be investigated rigorously as a differential diagnosis in immunosuppressed patients.
新型隐球菌是一种有荚膜的酵母，也是人类最常见的隐球菌。隐球菌病被认为是一种机会性感染，主要影响免疫抑制个体。在人类中，新型隐球菌引起三种类型的感染：肺部隐球菌病、隐球菌性脑膜炎和伤口或皮肤隐球菌病。
一位 81 岁女性的左臂出现严重坏死性蜂窝织炎，此前无任何外伤。患者因类风湿关节炎（RA）已接受了二十多年的全身性皮质类固醇治疗。最初对伤口区域的皮肤活检被解释为病因不明的皮肤血管炎。然而，过碘酸希夫染色和涂片分析后来显示与新型隐球菌一致的结构，随后通过培养确认了感染。开始每天使用氟康唑 400mg 治疗后，患者的一般情况和皮肤溃疡迅速改善，并出院到康复机构。随后进行了外科清创和植皮。
机会性感染，如隐球菌病，在临床上和组织学上可能类似于皮肤血管炎，在免疫抑制患者中必须作为鉴别诊断进行严格检查。
