CUTANEOUS CRYPTOCOCCOSIS - PRIMARY VERSUS SECONDARY DISEASE - REPORT OF 2 CASES WITH REVIEW OF LITERATURE

The clinical, immunological, and pathological features of solitary cut aneous cryptococcosis in two apparently healthy Chinese adults are rep orted. In patient 1, regional cryptococcal lymphadenopathy also occurr ed. Both patients showed lymphopenia with a proportionate decrease in T-helper and T-suppressor cells. Both skin and lymph node biopsies sho wed granulomatous inflammation and the presence of cryptococcus. A cha ncriform syndrome developed in patient 1, indicating primary cutaneous cryptococcosis. Chancriform syndrome is rare in cryptococcal skin inf ection, probably due to immunosuppression in susceptible patients. In patient 2, the deep dermal and subcutaneous inflammatory involvement a nd anatomic location of the lesion on the upper medial thigh are suppo rtive of secondary skin disease. Unless negated by a reliable history, the following features are indicative of secondary disease: inflammat ion centered in deep dermis or subcutaneous fat, lesion on covered par ts of body, and multifocal skin lesions. Some cases remain unclassifia ble. In practice the distinction between primary and secondary cutaneo us cryptococcal disease is not essential because less toxic, effective antifungal drugs are now available.