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June 2000
Case of the Month: A nine year-old HIV-infected girl presents with a lesion on her face.
Answer: Cutaneous Cryptococcus neoformans infection
Discussion: Cryptococcal infection in individuals with AIDS can manifest
with meningoencephalitis, pneumonia, or disseminated disease, which
sometimes includes skin lesions. Cutaneous cryptococcosis is included in
the differential diagnosis of a variety of skin lesions in individuals with
HIV, and must be promptly recognized and treated. Skin lesions can be
single or multiple, and may appear as small papules, pustules, nodules, or
ulcers with a base of granulation tissue. Umbilicated papules in
individuals with HIV can resemble molluscum contagiosum. Diagnosis can be
made by periodic acid-Schiff (PAS) staining of biopsy specimens, which may
reveal encapsulated budding yeast. Cultures of tissue or blood, and
determination of cryptococcal antigen titers by latex agglutination, can be
helpful. Treatment of cutaneous cryptococcosis is not well established.
Cases of disseminated disease require systemic induction therapy, usually
with amphotericin B or fluconazole, followed by life-long suppressive
therapy with fluconazole.
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