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Killblane T, Milsap D, Vetos D, Grantham DC, Hagan M. Cryptococcal Necrotizing Fasciitis in a Patient With Sarcoidosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Bernardes T, Ostilla L, Fazal A, Nasseri-Nik N, Otrakji C, Haddad G, Murillo J. When in Doubt, Cut It Out: Biopsy as Key in Diagnosing Cryptococcal Soft Tissue Infection. Cureus 2022; 14:e21111. [PMID: 35165569 PMCID: PMC8830359 DOI: 10.7759/cureus.21111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/05/2022] Open
Abstract
Soft tissue infection is an uncommon presentation of Cryptococcus in the absence of immunosuppression. Most infected patients present with pneumonia or meningitis, often with signs of disseminated disease, which may be fatal. We present a case of an 81-year-old mildly immunocompromised woman with multiple comorbidities, who presented with an extensive soft tissue infection on her right medial thigh. Superficial skin culture grew vancomycin-resistant Enterococcus; however, both initial and subsequent antibacterial therapies failed to resolve the infection. Subsequent biopsy revealed abundant yeasts, and mucicarmine staining confirmed Cryptococcus infection in a patient with no evidence of disseminated disease. Wound debridement and fluconazole for six months resulted in complete resolution of the lesion. In this report, we emphasize the need for tissue biopsy and microbial cultures in diagnosing patients with atypical skin and soft tissue infections who do not respond to appropriate antibiotics.
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Liu J, Li M, Liang JY, Xu XF, Zeng WG, Wang YJ, Jiang Y, Peng FH. Autoimmune diseases in HIV-negative cryptococcal meningitis. Future Microbiol 2021; 16:1251-1259. [PMID: 34674547 DOI: 10.2217/fmb-2020-0318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: The purpose of our study was to assess the differences between HIV-negative cryptococcal meningitis (CM) patients with and without autoimmune diseases. Methods: A total of 43 CM patients with autoimmune diseases and 67 without autoimmune diseases were enrolled for analysis. Results: CM patients with autoimmune diseases had higher fever, modified Rankin Scale scores, C-reactive protein and erythrocyte sedimentation rate, but had lower rates of visual and hearing symptoms, ventriculoperitoneal shunts, MRI meningeal enhancement and amphotericin B treatment, as well as lower cerebrospinal fluid pressure and fungal counts. When divided according to gender, each group had lower intracranial pressure and higher inflammation indicators. No differences in outcomes, sequelae and mortality hazard were found. Fluconazole treatment was a prognostic factor for CM without autoimmune diseases. Conclusions: Both antifungal and anti-inflammatory therapy should be considered in CM patients with autoimmune diseases.
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Affiliation(s)
- Jia Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Min Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia-Yin Liang
- Department of Laboratory, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Feng Xu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen-Gao Zeng
- Department of Neurology, Changsha Central Hospital, Changsha, 410018, China
| | - Yi-Jie Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fu-Hua Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Intraepithelial autoimmune bullous dermatoses disease activity assessment and therapy. J Am Acad Dermatol 2021; 84:1523-1537. [PMID: 33684497 DOI: 10.1016/j.jaad.2021.02.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/30/2022]
Abstract
Intraepithelial autoimmune blistering dermatoses are a rare group of skin disorders characterized by disruptions of inter-keratinocyte connections within the epidermis through the action of autoantibodies. The second article in this continuing medical education series presents validated disease activity scoring systems, serologic parameters of disease, treatments, and clinical trials for pemphigus and its subtypes.
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Kapp DL, Rogers M, Hermans MHE. Necrotizing Fasciitis: An Overview and 2 Illustrative Cases. INT J LOW EXTR WOUND 2018; 17:295-300. [PMID: 30422020 DOI: 10.1177/1534734618804037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Necrotizing fasciitis is the generic term for a series of progressive gangrenous infections of the skin and subcutaneous tissues. Typically, necrotizing fasciitis start with an, often small, infected lesion with atypical symptoms, which then quickly develops into a rapidly spreading, massive infection. The primary therapy is excision of all necrotic tissue in combination with treatment of systemic symptoms such as shock. The defects resulting from rigorous excision are often very large. Once they are clean, they require closure with an autograft. This article reviews the symptoms and treatment of necrotizing fasciitis. In addition, it illustrates, with 2 cases, how a hyaluronic-based extracellular matrix can be used to "fill in" with neodermis for the lost dermis and can create a wound bed most suitable for grafting.
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Mergler R, Kerstan A, Schmidt E, Goebeler M, Benoit S. Atypical Clinical and Serological Manifestation of Pemphigus Vegetans: A Case Report and Review of the Literature. Case Rep Dermatol 2017; 9:121-130. [PMID: 28559810 PMCID: PMC5437479 DOI: 10.1159/000468919] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022] Open
Abstract
Pemphigus vegetans (PVeg) is a rare variant of pemphigus vulgaris characterized by pustules and/or papillomatous vegetations, preferentially affecting intertriginous and periorificial areas. Exceptional manifestations may be misdiagnosed resulting in delayed diagnosis and treatment. Diagnosis is confirmed by immunofluorescence and detection of anti-desmoglein (Dsg) 3 and/or anti-Dsg1 antibodies. We herein report an unusual manifestation of PVeg. At the time of first presentation, lesions were restricted to the right ring finger's tip. Although mucous membranes were initially not affected, high levels of anti-Dsg3 antibodies were detected while anti-Dsg1 and anti-desmocollin (Dsc) 1, 2, and 3 antibodies were absent. To compare our immunological findings with previous reports, all accessible Anglophone literature published since December 1988 was evaluated. We identified 52 patients suffering from PVeg, 7 of these showed anti-Dsg3 antibodies without any mucous membrane involvement. Notably, the detection of anti-Dsg1 and anti-Dsg3 antibodies does not necessarily correlate with the involvement of skin and/or mucous membranes. This might be due to more specific and complex antibody constellations in nonclassical or atypical pemphigus.
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Affiliation(s)
- Rebecca Mergler
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Kerstan
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Enno Schmidt
- bDepartment of Dermatology, Venereology and Allergology, University of Lübeck, Lübeck, Germany
| | - Matthias Goebeler
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Sandrine Benoit
- aDepartment of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Wlodek C, Ng Y, Bovill B, Johnson EM, Bhatt N, Shipley D. An unusual cause of cutaneous ulceration. Clin Exp Dermatol 2017; 42:226-229. [PMID: 28044361 DOI: 10.1111/ced.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C Wlodek
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
| | - Y Ng
- Department of Infectious Diseases, Southmead Hospital, Bristol, UK
| | - B Bovill
- Department of Infectious Diseases, Southmead Hospital, Bristol, UK
| | - E M Johnson
- Public Health England Mycology Reference Laboratory, Bristol, UK
| | - N Bhatt
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
| | - D Shipley
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Atarguine H, Hocar O, Abbad F, Rais H, Idalene M, Tassi N, Akhdari N, Moutaj R, Amal S. [Cutaneous cryptococcosis mimicking basal cell carcinoma and revealing systemic involvement in acquired immunodeficiency]. J Mycol Med 2015; 25:163-8. [PMID: 25959736 DOI: 10.1016/j.mycmed.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/03/2015] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cryptococcosis is a rare and a serious opportunistic infection that occurs primarily on the field of immunodeficiency. We report a case of disseminated cryptococcosis in acquired immunodeficiency syndrome revealed by unusual skin lesions. OBSERVATION A 52-year-old patient consulted for two crusty ulcerative lesions situated on the left supraorbital and on the nasal tip that appeared 6 months ago. He also reported respiratory symptoms present since one year, with dry cough and dyspnea, chronic headache and vomiting with no alteration in visual acuity. The mycological study of the skin biopsy on both lesions isolated Cryptococcus neoformans as well as in the sputum and cerebrospinal fluid. Serology of human immunodeficiency virus infection was positive. Treatment with fluconazole, local care and antiretroviral triple therapy was implemented. DISCUSSION Skin lesions during cryptococcosis are rare and observed in 2-10% of cases. Cutaneous symptoms were the reason for consultation in our patient. This is a rare form of cutaneous cryptococcosis leading to the discovery of both pulmonary and central nervous system locations, and to diagnosis of HIV infection.
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Affiliation(s)
- H Atarguine
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc.
| | - O Hocar
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - F Abbad
- Service d'anatomie pathologique, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - H Rais
- Service d'anatomie pathologique, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - M Idalene
- Service de maladies infectieuses, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - N Tassi
- Service de maladies infectieuses, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - N Akhdari
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - R Moutaj
- Service de parasitologie-mycologie médicale, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital militaire Avicenne, CHU Mohamed VI, 40000 Marrakech, Maroc
| | - S Amal
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, hôpital Errazi, CHU Mohamed VI, 40000 Marrakech, Maroc
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Richardson TE, Lee NE, Cykowski MD, Chang SA, Powell SZ. Necrotizing fasciitis as the initial presentation of disseminated infection with fluconazole-resistant Cryptococcus neoformans. JMM Case Rep 2014; 1:e003608. [PMID: 28663814 PMCID: PMC5415936 DOI: 10.1099/jmmcr.0.003608-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/12/2014] [Indexed: 01/21/2023] Open
Abstract
Introduction: Cryptococcus neoformans is an encapsulated budding yeast that is a common cause of opportunistic infections, rarely giving rise to cellulitis, vasculitis or fasciitis. Necrotizing fasciitis caused by C. neoformans is a rare but serious problem in post-transplant immunosuppression. Case presentation: We report a case of cryptococcal necrotizing fasciitis in the left adductor longus of a patient on immunosuppressive therapy. The patient’s medical history was significant for orthotopic heart transplant secondary to cardiac and systemic amyloidosis (AL type) with subsequent cardiac biopsy demonstrating mild rejection (grade 1R). A thigh muscle biopsy demonstrated numerous encapsulated fungi in the fascia and no evidence of myositis. Cryptococcal antigen was subsequently identified in the patient’s serum and cerebrospinal fluid. The patient progressed to involvement of the central nervous system, left biceps femoris and skin of the left lower leg by fluconazole-resistant C. neoformans. Conclusion: This case illustrates a rare initial presentation of disseminated fluconazole-resistant C. neoformans as an isolated necrotizing fasciitis of the thigh. Necrotizing fungal fasciitis should be considered in immunosuppressed patients with clinical findings of either myositis or cellulitis of a lower extremity.
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Affiliation(s)
- Timothy E Richardson
- Texas College of Osteopathic Medicine and The Department of Pharmacology & Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Nathan E Lee
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Spencer A Chang
- Department of Radiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX 77030, USA
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Gu GL, Wang L, Wei XM, Li M, Zhang J. Necrotizing fasciitis secondary to enterocutaneous fistula: Three case reports. World J Gastroenterol 2014; 20:7988-7992. [PMID: 24976737 PMCID: PMC4069328 DOI: 10.3748/wjg.v20.i24.7988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/15/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.
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Li F, Yang HM, Wang HW. Disseminated cryptococcosis with widespread necrotizing fasciitis and cryptococcemia occurring in an immunosuppressed patient. Ann Dermatol 2014; 26:273-5. [PMID: 24882993 PMCID: PMC4037691 DOI: 10.5021/ad.2014.26.2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/25/2013] [Accepted: 05/10/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Feng Li
- Department of Burns and Plastic Surgery, the First Affiliated Hospital of the General Hospital of People's Liberation Army of China, Beijing, China
| | - Hong-Ming Yang
- Department of Burns and Plastic Surgery, the First Affiliated Hospital of the General Hospital of People's Liberation Army of China, Beijing, China
| | - Hong-Wei Wang
- Department of Burns and Plastic Surgery, the First Affiliated Hospital of the General Hospital of People's Liberation Army of China, Beijing, China
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Fallah H, Watson A, Henderson CJA, Woodford P, Bothman J, McCrossin I. Cryptococcosis presenting as upper limb cellulitis and ulceration: A case series. Australas J Dermatol 2011; 52:288-91. [DOI: 10.1111/j.1440-0960.2011.00820.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lehman JS, Murrell DF, Camilleri MJ, Kalaaji AN. Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders. Dermatol Clin 2011; 29:591-8. [DOI: 10.1016/j.det.2011.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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