Tapiz A, Vila D, Valdés V, Dorca E, Badal J, Marcos J M
Servicio de Medicina Interna, Hospital General de Manresa.
Rev Clin Esp. 1994 Sep;194(9):689-91.
We report an exclusively cutaneous case of cryptococcosis, which is exceptional. He was a 33 years old patient with the acquired immunodeficiency syndrome who presented with an ulcer-necrotic lesion at the nasal wings with a long and torpid evolution. Finally, culture and biopsy were diagnostic of cryptococcosis. We ruled out affection of other organs and the cryptococcal antigen was negative in serum and cerebrospinal fluid. The patient was treated with fluconazole and had a good clinical course. Its emphasized the scarcity of this form of presentation as well as the lack of specificity of its lesions and the necessity of ruling out other locations once the fungus is isolated in the skin. Diagnosis is simple through skin biopsy and culture. Its important to determine the cryptococcal antigen. We comment on the current approaches to treatment during acute and maintenance phases, after the appearance of the new imidazolic compounds such as fluconazole.
我们报告了一例罕见的仅累及皮肤的隐球菌病病例。患者为一名33岁的获得性免疫缺陷综合征患者，鼻翼处出现溃疡坏死性病变，病程漫长且进展缓慢。最终，通过培养和活检确诊为隐球菌病。我们排除了其他器官受累，血清和脑脊液中的隐球菌抗原均为阴性。患者接受氟康唑治疗，临床过程良好。这一病例凸显了这种表现形式的罕见性、其病变缺乏特异性，以及在皮肤中分离出真菌后排除其他部位感染的必要性。通过皮肤活检和培养诊断较为简单。确定隐球菌抗原很重要。我们讨论了在出现氟康唑等新型咪唑类化合物后，急性和维持期的当前治疗方法。
