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doi:
10.25259/JSSTD_23_2019
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Disseminated cryptococcosis

Department of Dermatology, Government Medical College, Kozhikode, Kerala, India
Department of Dermatology, ARMA MED ZITY, Malappuram, Kerala, India
Department of Microbiology, Medical College, Kozhikode, Kerala, India
Corresponding author: Dr. Anza Khader, 5/1986 B, “Maskan” Rajiv Nagar Colony, P O Puthiyara, Kozhikode - 673 004, Kerala, India. anzashaan@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Khader A, Nair S, Asokan J. Disseminated cryptococcosis. J Skin Sex Transm Dis 2019;1(2):110-1.

A 42-year-old HIV-positive male patient with CD4 count 32 cells/mm3 on antiretroviral therapy presented with fever of 3 weeks duration, altered sensorium, aggressive behavior, and weakness of limbs and skin lesions of 1 week duration. On examination, the patient was drowsy, deep tendon reflexes were sluggish and there was neck stiffness with positive Kernig’s sign. Dermatological examination revealed multiple papules with central umbilication and crusting over forehead, cheeks, earlobes, and inner canthus of the left eye [Figures 1 and 2a-d]. Leishman stain of tissue smear revealed thick-walled yeasts. Gram stain of cerebrospinal fluid yielded Gram-positive budding rounded yeast cells surrounded by Gram-negative capsule [Figure 3]. Indian ink preparation was positive for Cryptococcus in cerebrospinal fluid. The patient succumbed to illness 2 weeks later.

Figure 1:: Dome-shaped papule with central umbilication and crusting over the right ear lobe.
Figure 2:: (a) Papule with central umbilication on the left side of forehead. (b) Erythematous papule with central erosion over medial epicanthal fold of the right eye. (c) Dome-shaped papule with central umbilication and crusting over the left ear. (d) Umbilicated papules over the right cheek.
Figure 3:: Gram-positive rounded budding yeast cell surrounded by Gram-negative capsule in cerebrospinal fluid (Gram stain, ×400).

Disseminated cryptococcosis is defined as cryptococcosis affecting two or more non-adjacent organs simultaneously. Disseminated cryptococcosis was diagnosed due to skin and central nervous system involvement. Gram stain of cerebrospinal fluid is a highly sensitive but simple and reliable method in the diagnosis of cryptococcal meningitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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