CUTANEOUS CRYPTOCOCCOSIS IN CORTICOSTEROID-TREATED PATIENTS WITHOUT AIDS

Two corticosteroid-treated patients with cutaneous cryptococcal infect ion are described. One patient had pustulous lesions on the back of hi s left hand and cellulitis of his left forearm, the other patient had ulcerous lesions of the right forearm and cellulitis of the right lowe r leg. In both cases diagnosis was suggested by histopathological exam ination of a biopsy and confirmed by culture. One patient may have had disseminated cryptococcal disease as suggested by a positive cryptoco ccal capsular antigen test, the other had no evidence of dissemination . Treatment consisted of oral fluconazole for six weeks. One patient d ied of an unrelated cause after four weeks treatment. Secondary antifu ngal prophylaxis was not given. Cutaneous cryptococcal infections are described in AIDS patients, but only seldom observed in other immunoco mpromised patients. Early recognition of the cutaneous lesions is impo rtant, as they can be the first sign of disseminated cryptococcosis. U ntreated, the mortality of this disease is high. Therapy consists of a mphotericin B with or without flucytosine. Fluconazole may be a valuab le alternative. The optimal treatment regimen and duration are not def ined yet. Contrary to AIDS patients with cryptococcal infection, who n eed life-long secondary antifungal prophylaxis in order to prevent rel apses, suppressive treatment is not indicated for immunocompromised no n-AIDS patients.