An unusual case of disseminated cryptococcosis in an immunocompetent host presenting with verrucous skin lesions

Abstract

Disseminated cryptococcosis, commonly linked to immunocompromised conditions like HIV infection, is exceedingly rare in immunocompetent individuals. This case report presents a rare case of disseminated cryptococcosis in an immunocompetent patient, who manifested with fever, weight loss, neurological manifestations, and distinct verrucous skin lesions. Mycological cultures and histopathological assessments were conducted, leading to the identification of Cryptococcus neoformans var. gattii within both lung and skin biopsies. This case highlights the significance of considering this yeast infection within immunocompetent individuals and the necessity for promptly initiating appropriate antifungal therapy to enhance patient outcomes.

Keywords: Cryptococcus gattii; Disseminated cryptococcosis; Immunocompetent host; PET scan; Verrucous lesion.

Fig. 1

Clinical Image. Erythematous, sessile, dome-shaped nodules covered by crusts distributed on the forehead, cheeks, nose, upper lip, and scalp.

Fig. 2

Brain (head) magnetic resonance imaging (MRI). Multiple intra-axial expansive lesions diffused through the supra and infratentorial compartments, with emphasis on lesions in the nucleus capsular region, mesencephalic transition, and in the periphery of the right cerebellar hemisphere, determining an expansive effect with a deviation of the contralateral cerebellar vermis.

Fig. 3

Positron emission tomography (PET) scan Image. Increased glycolytic metabolism in expansive solid lesions with central calcification disseminated in the brain parenchyma, forehead, and scalp.

Fig. 4

Skin Biopsy A – A biopsy specimen of the skin obtained from the patient’s forehead showed numerous yeastlike organisms (white arrows) surrounded by a thick clear mucoid capsule (halo) not stained by H & E − (Hematoxylin and eosin stain. Original magnifications: A–D, × 400). B – Highlighting the mucin presence in the Cryptococcus capsules (black arrows) – (Alcian blue stain. Original magnifications: A–D, × 400). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)