CASE REPORT: Disseminated cryptococcal infection initially presenting as cryptococcal cellulitis in an HIV-negative patient on long-term steroids

Kerr, Colm
Stack, William A
Sadlier, Corinna
Jackson, Arthur

¹Infectious Diseases, Cork University Hospital Group, Cork, Ireland,
²Gastroenterology and General Medicine, Bon Secours Hospital, Cork, Ireland,
³Acute Medicine/Infectious Diseases, Cork University Hospital Group, Cork, Ireland,
⁴Infectious Diseases, Cork University Hospital/Mercy University Hospital, Cork, Ireland,

Correspondence to Dr Colm Kerr, e-mail; [email protected]

/Accepted October 26, 2018; previously published online November 28, 2018

Contributors This manuscript has been compiled and reviewed by all four authors. AJ, CK, WAS & CS were involved in the conception and planning of this case report as all were directly involved in the patient's care pathway both in an inpatient and outpatient capacity. Both AJ and CS have significant expertise in cryptococcal infection in their capacity as consultants in infectious diseases, and contributed to the discussion segment of the case report, as did CK who is a trainee in infectious diseases. AJ, CK and WAS contributed to the design and concept of the case report; in particular, WAS was heavily involved in its evolution from draft to submission.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent Obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

BMJ Case Reports 11(1):p e227249, November 2018. | DOI: 10.1136/bcr-2018-227249

Cryptococcosis is an invasive fungal infection caused by encapsulated yeasts of the Cryptococcus species. Inoculation usually occurs by inhalation through the respiratory tract, where it can then spread haematogenously to various sites, such as the central nervous system or the skin, in susceptible patients. We present the case of a 68-year-old male patient on long-term steroids who presented with a right upper limb cellulitis not responding to antibiotics. This was subsequently diagnosed as cryptococcal cellulitis on an urgent skin biopsy. Wound swabs and blood cultures, which were initially negative, were repeated and confirmed the presence of disseminated cryptococcal disease. The patient's neighbours kept racing pigeons and this was hypothesised as a potential source of infection.