CUTANEOUS LESIONS OF DISSEMINATED CRYPTOCOCCOSIS AS THE INITIAL PRESENTATION OF ADVANCED HIV-INFECTION

Cutaneous lesions of disseminated cryptococcosis as the first clinical evidence of acquired immunodeficiency syndrome (AIDS) is described in three cases. The clinical diagnosis was difficult because of the poly morphism of lesions, absence of general symptoms and the patients' una wareness of their HIV infection. Patient 1 had central nervous system involvement and a poor prognosis. Patients 2 and 3 had cutaneous lesio ns only and have remained in relatively good health at 18- and 14-mont h follow-ups, respectively, after treatment. The patients were treated with amphotericin B 0.5mg/kg per day for 6 weeks and oral fluconazole at 300 mg/day. The cutaneous lesions healed in 30 days. Because the h igh risk of relapse, long-term suppressive therapy was instituted with oral fluconazole 300 mg/day, supplemented with three weekly amphoteri cin infusions. To the best of our knowledge, cutaneous cryptococcosis as the presenting sign of HIV infection has not been previously report ed in medical literature. (C) 1997 Elsevier Science Ireland B.V.