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Disseminated Cryptococcosis Presenting as Cutaneous Cellulitis in an Adolescent With Systemic Lupus Erythematosus.

Valente ES, Lazzarin MC, Koech BL, da Rosa RV, de Almeida R, de Oliveira UL, Neugebauer MG, Sacco AG - Infect Dis Rep (2015)

Bottom Line: Prior to diagnosis, she was a chronic user of corticosteroids and other immunosuppressive drugs.Her first symptoms were skin lesions that simulated bacterial cellulitis.Appropriate therapy was established, and the patient was discharged after 42 days of treatment in complete remission.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Federal University of Pelotas , Brazil.

ABSTRACT
We report here the case of a 17-year-old girl from Pelotas, Brazil, with systemic lupus erythematosus and disseminated cryptococcal infection. Prior to diagnosis, she was a chronic user of corticosteroids and other immunosuppressive drugs. Her first symptoms were skin lesions that simulated bacterial cellulitis. Upon suspicion, we performed a biopsy and fungal infection was confirmed. Appropriate therapy was established, and the patient was discharged after 42 days of treatment in complete remission.

No MeSH data available.


Related in: MedlinePlus

A) Right lower extremity lesions, which were blistered, painful upon palpation, and showed signs of inflammation. B) Purulent secretion draining from the lesions.
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fig002: A) Right lower extremity lesions, which were blistered, painful upon palpation, and showed signs of inflammation. B) Purulent secretion draining from the lesions.

Mentions: Bacterial cellulitis was suspected due to the worsening of the lesions, which were blistered, painful upon palpation, and showed signs of inflammation (Figure 2A). Treatment with ceftriaxone and vancomycin was initiated. Four days later, purulent secretion began to drain from these lesions (Figure 2B). This material was collected and analyzed: there was no bacterial growth, and C. neoformans was identified by direct examination. C. neoformans grew in culture. Therefore, fluconazole (400 mg/day, IV) was added to amphotericin B therapy. During the last week of hospitalization, her RLE lesions improved (i.e. pus draining and swelling disappeared); also the pain ceased. Clinically, the patient improved without any neurological or pulmonary sequelae. Laboratory tests previous to hospital discharge revealed hemoglobin levels of 9.2 g/dL, a WBC count of 16.700 cells per mm³, platelet count of 303.000 cells per mm³, AST 10 U/L and ALT 4 U/L, and CRP levels of 6.88 mg/L and ESR of 53 mm. The patient was discharged after 42 days of IV treatment with amphotericin B. She was instructed to continue fluconazole (400 mg/day) at home for 8 weeks and then reduced its dose to 200 mg/day for 1 year.


Disseminated Cryptococcosis Presenting as Cutaneous Cellulitis in an Adolescent With Systemic Lupus Erythematosus.

Valente ES, Lazzarin MC, Koech BL, da Rosa RV, de Almeida R, de Oliveira UL, Neugebauer MG, Sacco AG - Infect Dis Rep (2015)

A) Right lower extremity lesions, which were blistered, painful upon palpation, and showed signs of inflammation. B) Purulent secretion draining from the lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508533&req=5

fig002: A) Right lower extremity lesions, which were blistered, painful upon palpation, and showed signs of inflammation. B) Purulent secretion draining from the lesions.
Mentions: Bacterial cellulitis was suspected due to the worsening of the lesions, which were blistered, painful upon palpation, and showed signs of inflammation (Figure 2A). Treatment with ceftriaxone and vancomycin was initiated. Four days later, purulent secretion began to drain from these lesions (Figure 2B). This material was collected and analyzed: there was no bacterial growth, and C. neoformans was identified by direct examination. C. neoformans grew in culture. Therefore, fluconazole (400 mg/day, IV) was added to amphotericin B therapy. During the last week of hospitalization, her RLE lesions improved (i.e. pus draining and swelling disappeared); also the pain ceased. Clinically, the patient improved without any neurological or pulmonary sequelae. Laboratory tests previous to hospital discharge revealed hemoglobin levels of 9.2 g/dL, a WBC count of 16.700 cells per mm³, platelet count of 303.000 cells per mm³, AST 10 U/L and ALT 4 U/L, and CRP levels of 6.88 mg/L and ESR of 53 mm. The patient was discharged after 42 days of IV treatment with amphotericin B. She was instructed to continue fluconazole (400 mg/day) at home for 8 weeks and then reduced its dose to 200 mg/day for 1 year.

Bottom Line: Prior to diagnosis, she was a chronic user of corticosteroids and other immunosuppressive drugs.Her first symptoms were skin lesions that simulated bacterial cellulitis.Appropriate therapy was established, and the patient was discharged after 42 days of treatment in complete remission.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Federal University of Pelotas , Brazil.

ABSTRACT
We report here the case of a 17-year-old girl from Pelotas, Brazil, with systemic lupus erythematosus and disseminated cryptococcal infection. Prior to diagnosis, she was a chronic user of corticosteroids and other immunosuppressive drugs. Her first symptoms were skin lesions that simulated bacterial cellulitis. Upon suspicion, we performed a biopsy and fungal infection was confirmed. Appropriate therapy was established, and the patient was discharged after 42 days of treatment in complete remission.

No MeSH data available.


Related in: MedlinePlus