Primary cutaneous cryptococcosis in a patient with systemic immunosuppression after liver transplantation

We report a 36-year-old woman who slowly developed an ulceration on the lef t thigh 2 years after transplantation for Budd-Chiari syndrome. At this tim e point, the patient was treated with prednisone, tacrolimus and azathiopri ne for immunosuppression and with phenprocoumon and low-dose aspirin for an ticoagulation in the presence of polycythemia vera. A biopsy of the skin le sion was obtained and revelaed encapsulated yeast that was identified by mi crobiological and serological methods as Cryptococcus neoformans serotype D . The patient had no signs of systemic infection and a therapy with flucona zole (200 mg/day) was started. The lesion healed within 8 weeks and flucona zole was stopped after 3 months. Due to interactions between fluconazole, t acrolimus and phenprocoumon, the latter drugs were decreased to prevent tox icity. So far, 1 month after slopping fluconazole, no recurrence of skin le sions has been observed. Copyright (C) 2000 S. Karger AG, Basel.