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Disseminated Cryptococcosis Presenting as Cellulitis Diagnosed by Laser Capture Microdissection: A Case Report and Literature Review

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Abstract

Disseminated cryptococcosis primarily affects immunosuppressed patients and has a poor outcome if diagnosis and treatment are delayed. Skin lesions are rarely manifest causing misdiagnosis. We present a case of cryptococcal cellulitis with severe pain in a kidney transplant recipient on long-term immunosuppressive therapy. Multiple organs were involved, and there was cutaneous dissemination of the lesions. Histopathology revealed abundant yeast-like cells with wide capsular halos in subcutaneous tissue, suggesting Cryptococcus spp. infection. Laser capture microdissection (LCM)-PCR on skin biopsies confirmed Cryptococcus neoformans var. grubii. A literature review of 17 cases of disseminated cryptococcosis with cutaneous cellulitis or panniculitis in HIV-negative individuals found that over half the patients (52.9%, 9/17) had a history of glucocorticoid therapy, and that the most common site was the legs (76.5%, 13/17). C. neoformans was the main pathogenic species, accounting for 88.2% (15/17) of cases. Fungal cellulitis should be included in the differential diagnosis of cellulitis that fails to respond to antimicrobial therapy in HIV-negative immunosuppressed individuals. Non-culture-based molecular techniques aid in rapid pathogen identification in histologically positive, unculturable specimens.

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Acknowledgments

The authors would like to thank the patient for allowing us to report this case and to Beijing Natural Science Foundation for their support [No. 7194326].

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Author notes

  1. Yinggai Song, Xiao Liu have contributed equally to this article.

Authors and Affiliations

  1. Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China

    Yinggai Song, Xiao Liu & Ruoyu Li

  2. Research Center for Medical Mycology, Peking University, Beijing, China

    Yinggai Song, Xiao Liu, G. Sybren de Hoog & Ruoyu Li

  3. National Clinical Research Center for Skin and Immune Diseases, Beijing, China

    Yinggai Song, Xiao Liu & Ruoyu Li

  4. Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China

    Yinggai Song, Xiao Liu & Ruoyu Li

  5. Center of Expertise in Mycology of Radboud University Medical Center / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    G. Sybren de Hoog

  6. Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands

    G. Sybren de Hoog

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Ruoyu Li and Yinggai Song designed and supervised the research and data analysis. Yinggai Song and Xiao Liu conducted research and drafted the manuscript. G. Sybren de Hoog contributed to design the study and the analysis of the data.

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Song, Y., Liu, X., de Hoog, G.S. et al. Disseminated Cryptococcosis Presenting as Cellulitis Diagnosed by Laser Capture Microdissection: A Case Report and Literature Review. Mycopathologia 186, 423–433 (2021). https://doi.org/10.1007/s11046-021-00543-3

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