An Exceptional Case Report of Primary Cutaneous Cryptococcosis in Human Immunodeficiency Virus

Problem statement: Cryptococcosis is an infection caused by the encapsulated yeast Cryptococcus neoformans, a dimorphic fungus. In patients with AIDS, skin manifestations represent the second most common site of disseminated Cryptococcosis. Approach: Mr. A 42 year old farmer was referred from Voluntary Counseling and Testing Centre (VCTC) with positive HIV status to the outpatient department with one week history of asymptomatic discrete papular lesions over the face. Extirpation of the papule led to expression of the colorless watery material, which on Indian ink and Grams staining showed presence of Cryptococci and his CD4 count was found to be 58 cells cu.mm^-1. Sabourauds Dextrose Agar (SDA) culture of the material from the skin lesion revealed growth of Cryptococci. CSF, blood and sputum culture were negative for pathogens, Chest X-ray did not reveal any abnormal findings. Results: A diagnosis of primary Cutaneous Cryptococcosis was made and the patient was treated with Intravenous Amphotericin B followed by oral Fluconazole along with other supportive measures and Anti retroviral therapy. He showed remarkable improvement following therapy. Conclusion: In advanced stages of Immunodeficiency, patients may present only with umbilicated papules without any associated constitutional symptoms. High degree of clinical suspicion, thorough history, detailed clinical examination and appropriate laboratory investigations are needed to diagnose primary cutaneous cryptococcosis as these lesions may be misdiagnosed as Molluscum Contagiosum.