蜂窩織炎様の臨床所見を呈した皮膚クリプトコッカス症

・免疫抑制患者に発症した皮膚クリプトコッカス症．

・蜂窩織炎様皮疹に始まり，水疱，血疱，潰瘍，壊死，結節を形成した．

・初期には臨床所見に比べ，血液検査上の炎症所見が軽度であった．

・病理所見では血管の閉塞像があり，壊死性筋膜炎に類似した病態が臨床像の形成に関与したと考えられる．

（「症例のポイント」より）

　

Cutaneous cryptococcosis manifesting cellulitis-like appearance

　

Furukawa, Yuki1）Katagiri, Kazumoto1） 1）Department of Dermatology, Dokkyo Medical University Saitama Medical Center

　

A 80 years-old woman gad a fever of 38℃ during hospitalization for the treatment of edema due to hepatocellular carcinoma. Well defined erythema with vigorous tenderness, swelling and local heat developed on an inner aspect of right thigh in spite of administration of antibiotics. Skin biopsy revealed encapsulated yeasts in the edematous dermis with focal lymphocytic infiltration and in the superficial subcutaneous fat with thrombosed vessels. She was finally diagnosed as having cutaneous cryptococcosis based on the results of skin biopsy, and mycological culture, although she had no focus of cryptococcosis in any organs including lung and brain. Vesicles, bullae, ulcers, and necrosis appeared in the erythema within a following week before diagnosis. Necrosis in the thigh expanded and nodules newly appeared on the buttocks and on the left forearm after systemic administration of fluconazole. New cutaneous lesions did not appear after changing to amphotericin B and flucytosine, whereas she died 25 days after development of erythema on her thigh. Cutaneous cryptococcosis should be considered for atypical cellulitis in the immune compromised patients.