Bullous cellulitis with Cryptococcus neoformans

Excerpt

A 79-year-old immunocompromised pigeon farmer presented with a 2-week history of a well-demarcated redness and swelling of his left hand spreading to the upper arm. His medical history was remarkable for untreated myelodysplastic syndrome. Despite antibiotic treatment for assumed bacterial cellulitis, he developed progressive erythema, partial skin necrosis, and hemorrhagic epidermal bullae (Fig. 1a). Examination of deep skin biopsy specimens revealed granulomatous inflammation and encapsulated yeasts compatible with Cryptococcus neoformans (Fig. 1b, c), which was subsequently confirmed in microbiological culture. Fluconazole therapy was initiated, and several surgical debridements were performed. The patient is currently receiving antifungal treatment on an outpatient basis and is in good health. …