Cutaneous cryptococcosis erroneously diagnosed as histoplasma capsulatum infection

Abstract

A 31-year-old patient with stage 4 HIV/AIDS presented with recurrent painful skin ulcers for more than 8 months. These would start as subcutaneous skin nodules, later becoming fluctuant and suppurating and then healing spontaneously (Fig. 1). The patient had lesions on the left wrist, left posterior thigh, right axilla, right posterior calf and right upper eyelid. He had also been diagnosed with extrapulmonary tuberculosis and had been on highly active antiretroviral therapy (HAART) for 8 months and antituberculosis medication (continuation phase). After initial poor adherence to both groups of drugs, compliance had improved. The CD4 count at baseline was 16 cells/µl and the latest result was 80 cells/µl. Histological analysis of a biopsy specimen taken from the right upper eyelid lesion showed granulation tissue with some acute inflammation. Fungal spores were seen in the exudates and stains revealed ‘capsule-deficient’ fungi that were first thought to be Histoplasma, and were reported as such.