播種性クリプトコッカス症─丘疹-紅皮症（太藤）治療中に皮膚生検を契機に診断に至った1例─

・丘疹‒紅皮症（太藤）に対し，プレドニゾロン内服中に，左大腿に3個の皮下結節が出現し，一部が潰瘍化した．

・皮膚生検でGrocott染色，PAS染色で菌要素を認め，クリプトコッカス症が疑われた．

・肺病変を認め，血液検査でクリプトコッカス抗原陽性で，播種性クリプトコッカス症と確定診断した．

・抗真菌薬投与および潰瘍の局所処置で治癒した．

（「症例のポイント」より）

　

Disseminated cryptococcosis diagnosed after skin biopsy in a patient with papuloerythroderma (Ofuji) : a case report

　

Fukumoto, Ayako1）Imamura, Shinya2）Nishiyama, Satoshi2）Nishigori, Chikako2）Kamiryo, Hiroshi3） 1）Division of Dermatology, Nishinomiya Municipal Central Hospital 2）Department of Dermatology, Kobe University School of Medicine 3）Division of Respiratory Medicine, Kobe University School of Medicine

　

A 79-year-old man treated with prednisolone (17.5 mg/day)for papuloerythroderma(Ofuji)presented with one ulcerated and two subcutaneous nodules in his left thigh. Pathological examination revealed multiple circular structures of various sizes and specimens were stained positive with Grocott and periodic acid-Schiff. Additional examination revealed pulmonary lesions and the patient was diagnosed with cryptococcosis. He was treated with antifungal drugs for disseminated cryptococcosis and fully recovered. Diagnosing cutaneous cryptococcosis is challenging as it presents various clinical manifestations；therefore skin biopsies are indispensable for accurate differentiation and diagnosis.