Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy - a case report

• Published in: BMC infectious diseases 2017-04, Vol.17 (1), p.311-311, Article 311
• Main Authors: Huong, Nguyen Thi Cam, Altibi, Ahmed M A, Hoa, Nguyen My, Tuan, Le Anh, Salman, Samar, Morsy, Sara, Lien, Nguyen Thi Bich, Truong, Nguyen Thanh, Mai, Nguyen Thi Hoang, Hoa, Pham Thi Le, Thang, Nguyen Ba, Trung, Van The
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Case Report; Case reports; CD4 antigen; Cryptococcosis; Cryptococcosis - complications; Cryptococcosis - pathology; Cryptococcus; Cryptococcus meningitis; Cryptococcus neoformans - isolation & purification; Cryptococcus neoformans - pathogenicity; Cutaneous Cryptococcosis; Dermatomycoses - complications; Dermatomycoses - pathology; Diabetes; Diagnosis, Differential; Differential diagnosis; Encapsulation; Family medical history; Fungal infections; HIV; Human immunodeficiency virus; Humans; Immunodeficiency; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Infections; Infectious diseases; Lesions; Male; Meningitis; Meningitis, Cryptococcal - diagnosis; Meningitis, Cryptococcal - etiology; Myasthenia; Myasthenia gravis; Myasthenia Gravis - complications; Myasthenia Gravis - drug therapy; Neuromuscular junctions; Opportunist infection; Opportunistic Infections - complications; Pathogens; Patients; Skin; Skin diseases; Therapy; Thymoma; Yeast
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2415-8

Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature. We reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis. Through this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving.