DISSEMINATED CRYPTOCOCCOSIS PRESENTING AS MOLLUSCUM-LIKE LESIONS AS THE FIRST MANIFESTATION OF AIDS

A 41-year-old man had been Hiv-positive for 4 years and reported promi scuous heterosexual behavior as the only risk factor for HIV-infection , He denied intravenous drug abuse or homosexual partners and was seen in our clinic because of widespread papular skin lesions that had app eared 2 months before, The patient had a 7-day history of malaise, wei ght loss, fever, and nonproductive cough, Neurologic signs were absent on physical examination. Skin examination revealed numerous skin-colo red, umbilicated papules, 7 to 10 mm in diameter, located on the lace (Fig. 1), trunk, and the right thigh (Fig. 2), The shape, size, number , and location of the lesions strongly resembled molluscum contagiosum . A biopsy specimen showed numerous cryptococcal spores in the dermis with a sparse infiltrate, composed almost entirely of masses of free s pores in tissue known as gelatinous pattern (Fig. 3), This pattern is due to the weak immunologic response elicited by the mucinous capsule, Methenamine silver stained the spores but not the capsule and confirm ed the diagnosis of cryptococcosis (Fig. 4), At this time, his CD4 cou nt was 122 per mm(3), Cryptococcus neoformans was isolated from the sk in biopsy and cerebrospinal Fluid (CSF). Cryptococcal antigen was posi tive in both serum and CSF. The patient was treated with IV amphoteric in B, 0.5 mg per kg per day for 2 weeks, followed by fluconazole by mo uth, 400 mg per day, for 8 weeks, followed by life-long therapy with f luconazole, 200 mg per day, The cutaneous lesions on the thigh resolve d 5 weeks after beginning therapy, but the lesions on the face remaine d clinically apparent 5 months later.