Disseminated and cutaneous cryptococcosis by C. neoformans VNI in an immunocompetent patient

Abstract

ABSTRACT Cryptococcosis is caused by yeasts of the Cryptococcus neoformans/C. gattii complex, presenting cutaneous, respiratory and disseminated forms. A 44-year-old immunocompetent male with facial lesion and latent pneumonia was hospitalized and misdiagnosed with paracoccidioidomycosis. Computerized tomography scans showed pulmonary and neurological involvement, and cultures/China ink, cryptococcal antigen test and restriction fragment length polymorphism of urease gene (URA5-RFLP) confirmed C. neoformans genotype VNI. Hemoculture indicated ampicillin-resistant Klebsiella pneumoniae (healthcare-associated infection). Fluconazole was administered, but after resistance detection, amphotericin B was chosen (cumulative dose/1500 mg). The patient was discharged with clinical remission (75 days) and amphotericin for one year (maintenance phase).

Keywords

• cryptococcosis
• cryptococcal meningitis
• Cryptococcus neoformans
• amphotericin B
• Klebsiella pneumoniae