Localized Cutaneous Cryptococcosis: Summary of Reported Cases in Japan

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  • Noguchi Hiromitsu
    Noguchi Dermatology Clinic Ochanomizu Institute for Medical Mycology and Allergology
  • Hiruma Masataro
    Ochanomizu Institute for Medical Mycology and Allergology
  • Maruo Keishi
    Division of Dermatology, Kumamoto Shinto General Hospital
  • Jono Masayoshi
    Division of Dermatology, Kumamoto Shinto General Hospital
  • Miyata Keishi
    Department of Immunology, Allergy & Vascular Biology, Kumamoto University
  • Tanaka Hideaki
    Tanaka Naika Ganka
  • Tanabe Koichi
    Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases
  • Miyazaki Yoshitsugu
    Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases
  • Ihn Hironobu
    Department of Dermatology and Plastic Surgery, Faculty of Life Science, Kumamoto University

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A 68-year-old male plasterer with no history of trauma presented to our clinic in March 2012 with a 16×14-mm ulcer that developed following a crushed small papule on the right anterior chest. In April 2012, the patient was referred to another hospital, where cutaneous cryptococcosis was diagnosed based on discharge culture results. The patient was treated with oral itraconazole at a dose of 150 mg/day for 10 weeks; however, the ulcer remained unchanged and he discontinued the treatment. In May 2014, when he revisited our clinic, the ulcer with crust had grown to 29×13 mm. No regional lymph node swelling was noted. India ink staining showed a yeast-like fungus with a thick, clear capsule. A cream-colored, viscous yeast-like colony was observed on Sabouraud dextrose agar. Genetic testing identified the isolate as Cryptococcus neoformans serotype A. The patient was negative for serum cryptococcal antigen. Neither chest radiography nor computed tomography revealed any abnormalities. The patient had no underlying disease. Oral fluconazole (400 mg/day for 12 weeks) was prescribed, resulting in scar formation. The patient has remained free of relapse for one year to date, since the end of treatment. Localized cutaneous cryptococcosis is not a commonly used disease name overseas. However, 36 cases of this disease have been reported in Japan (since in 1968). We herein report a new case with localized cutaneous cryptococcosis and summarize previously reported cases in Japan.

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