Solitary cutaneous cryptococcosis resembling chickenpox: a case report

We report a case of apparently solitary cutaneous cryptococcosis in an AIDS patient whose skin lesions resembled that of chickenpox. Cryptococcal infection occurs in HIV-infected patients with CD4 counts less then 200 x 10 super(6)/l. Cryptococcosis has been described in about 5-10% of patients with AIDS and virtually any organ may be infected. Only sporadic cases of primary cutaneous cryptococcosis have been reported; thus, there is still uncertainty whether the skin lesions may be a secondary disease rather than a primary cutaneous infection. In many cases it is difficult to distinguish primary cutaneous cryptococcosis from secondary cryptococcosis, and from other skin lesions such as molluscum contagiosum, Kaposi's sarcoma, and chickenpox, as in our case. In many cases, cutaneous cryptococcosis is secondary to disseminated infection, but may precede systemic symptoms by many months and may be an early sentinel of disseminated disease. Isolated primary cutaneous localization can result from cutaneous inoculation. We believe that our patient was accidentally infected with Cryptococus while he was restoring old furniture that had been exposed to the air in a courtyard where there was pigeon excrement.