Concurrent Primary Cutaneous Cryptococcosis and Bowen's Disease in a Patient With Multiple Sclerosis on Fingolimod: A Rare Case Report and Review of Literature

Fingolimod is an oral disease-modifying treatment used for the relapsing-remitting forms of multiple sclerosis, which may render patients susceptible to opportunistic infections and lead to an increased risk of skin cancer. We report a 56-year-old woman with multiple sclerosis in remission on fingol...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-10, Vol.16 (10), p.e71050
Main Authors: Gencebay, Gullu, Çetin, Nisan, Gecer, Melin, Su Kucuk, Ozlem
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Acne
Acquired immune deficiency syndrome
AIDS
Antibiotics
Antigens
Biopsy
Case reports
Cellulitis
Dermatology
Flow cytometry
Fungal infections
Hepatitis
HIV
Human immunodeficiency virus
Lymphocytes
Lymphoma
Melanoma
Multiple sclerosis
Oral diseases
Pathology
Patients
Sarcoma
Skin cancer
Squamous cell carcinoma
Ulcers
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Summary:Fingolimod is an oral disease-modifying treatment used for the relapsing-remitting forms of multiple sclerosis, which may render patients susceptible to opportunistic infections and lead to an increased risk of skin cancer. We report a 56-year-old woman with multiple sclerosis in remission on fingolimod treatment for five years presenting with the following skin lesions. Our patient presented with a non-healing ulcerated erythematous lesion on the left lower abdomen for six months and a crusted erythematous plaque on the forehead that had not healed for one year. Skin biopsy from the abdominal lesion showed fungal spores extending from the papillary dermis to the deep dermis, mostly in histiocytes and periodic acid-Schiff (PAS) staining revealed structures consistent with . A moderate infection was confirmed by culture. There were no systemic symptoms suggestive of secondary cutaneous cryptococcosis. In addition, a punch biopsy from the forehead showed findings compatible with Bowen's disease. Fingolimod was discontinued and the lesion on the left lower abdomen resolved with oral fluconazole therapy. Complete surgical excision with negative margin was performed for Bowen's disease. We present the first reported case of concurrent primary cutaneous cryptococcosis and Bowen's disease in the same patient with multiple sclerosis on fingolimod in the literature.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.71050