A 36-Year-Old Renal Transplant Recipient Female with Leg Ulcer: A Case Report and Brief Review

Abstract

Background: Opportunistic infections are common in organ transplant recipients. After 6 months of transplantation, patients have the highest risk of opportunistic infections such as cryptococcosis.

Case presentation: The report presents the case of a 36-year-old female renal transplant recipient, with complaints of few subcutaneous painful and warm nodules and large, warm, erythematous, nontender plaques on the mildly edematous right leg and ankle. Incisional biopsy of the subcutaneous nodule over the leg showed panniculitis with small- to medium-sized vasculitis associated with round yeast forms, and culture of the fragments revealed C. neoformans var. grubii.

Conclusions: This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed that since the cryptococcal cutaneous lesions are often nonspecific, the clinical picture solely is not enough to construct a definite diagnosis and there must be a high clinical suspicion.

Figure 1

(a to d) Large, warm, erythematous, nontender plaques and subcutaneous nodules on the edematous right leg and ankle in a renal transplant recipient on admission. (e and f) Hematoxylin and eosin shows fat necrosis and coagulative necrosis and rare foci of vasculitis as well as foci of RBC extravasation.

Figure 2

Rapid deterioration of ulcers and increase in the lesion size after 2 weeks.

Figure 3

(a) Periodic acid-Schiff (PAS), (b) alcian blue, and (c) colloidal iron stains were positive, but (d) Giemsa and (e) Prussian blue stains were negative for cryptococcus. (f) Mucicarmine stain was positive for cryptococcosis.