[Primary cutaneous cryptococcosis and bacterial pneumonia caused by Pseudomonas aeruginosa in AIDS: clinical case and review of the literature].

BACKGROUND

Clinically symptomatic infection due to Cryptococcus neoformans is found in 5-10% of patients with AIDS. It usually appears as meningitis with or without associated blood stream infection. In the last years, severe Pseudomonas aeruginosa infections in HIV (+) patients, with a high morbidity and mortality, are increasingly reported.

MATERIALS AND METHODS

A 27 year-old male HIV (+) patient, with previous opportunistic infections, was referred because of a nodular lesion on his left wrist, with an axillar homolateral lymph node of long-term evolution. Cryptococcus neoformans var. neoformans was isolated in pure culture from the lesion. Disseminated infection or affection of other organs was ruled out. Therapy with intravenous amphotericin B was initiated, but the patient developed an early nosocomial bacteremic pneumonia due to P. aeruginosa with a fatal outcome. A review of the literature about both complications in AIDS is carried out.

RESULTS

The fungal clinical picture is compatible with primary cutaneous cryptococcosis that is a rare condition (12 clinical reports until 1993), of which only one case report in an AIDS patient has been described in 1994. Since 1990 severe infections due to P. aeruginosa in HIV(+) patients are increasingly reported, and pneumonias, bacteremias, catheter-related sepsis, urinary tract infections, intraabdominal infections, central nervous system and othorrhinolaryngologic infections have been described in patients with AIDS in the English-language literature.

CONCLUSIONS

Primary cutaneous cryptococcosis is another rare form of infection with C. neoformans in patients with AIDS. The increasingly reported cases of severe infections due to P. aeruginosa could have important implications in the therapy of patients with AIDS.