Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami, Hiroshima, 734-8551, Japan.
Mycopathologia. 2019 Apr;184(2):341-343. doi: 10.1007/s11046-019-00322-1. Epub 2019 Feb 1.
An 82-year-old woman presented to our hospital with a deep skin ulcer in her right lower limb. Although the skin biopsy showed necrosis and neutrophil infiltration, we could not initially detect any pathogen. Chest radiography showed multiple nodules despite the lack of respiratory symptoms or fever, and the serum latex agglutination test for cryptococcus showed an elevated titer (1:512). Considering these findings, we performed additional stains of periodic acid-Schiff reaction and Grocott to the skin-biopsy specimen and detected multiple yeast-like fungi. The cultures of the skin and lung-biopsy specimens revealed Cryptococcus neoformans. In this case, it is suggested that a large deep skin ulcer can be an initial manifestation of systemic cryptococcosis, as, in some cases, pulmonary cryptococcosis may be asymptomatic. Second, cutaneous cryptococcosis of an unexposed area such as the thigh can contribute to the diagnosis of systemic cryptococcal infection because it is attributable to bloodstream dissemination from other organs.
一位 82 岁女性因右下肢深部皮肤溃疡就诊于我院。虽然皮肤活检显示坏死和中性粒细胞浸润，但我们最初未能检测到任何病原体。尽管患者无呼吸道症状或发热，胸部 X 线片仍显示多个结节，血清胶乳凝集试验检测隐球菌的滴度升高（1:512）。鉴于这些发现，我们对皮肤活检标本进行了过碘酸-雪夫（periodic acid-Schiff reaction）和 Grocott 染色，检测到多个酵母样真菌。皮肤和肺活检标本的培养显示新型隐球菌。在本例中，提示深部大皮肤溃疡可能是系统性隐球菌病的初始表现，因为在某些情况下，肺部隐球菌病可能无症状。其次，大腿等未暴露部位的皮肤隐球菌病有助于诊断系统性隐球菌感染，因为它归因于来自其他器官的血流播散。
