Cutaneous Cryptococcosis: A Sentinel of Disseminated Disease

In four cases of disseminated cryptococcosis with central nervous system (CNS) involvement, cryptococcal cutaneous lesions developed two to eight months before the diagnosis of disseminated cryptococcosis with meningitis was made. In all four patients, there was cultural or strong clinical evidence of multisystem involvement in addition to the presenting skin lesions and CNS involvement. All four patients were treated with amphotericin B intravenously. In two patients, a single course of drug therapy produced long-term apparent cure, while in the remaining two, clinical and cultural relapse occurred, resulting in death in spite of a second course of treatment. The recognition of cutaneous cryptococcal disease should alert the clinician to the probability of disseminated cryptococcosis. Repeated careful cultural studies of the cerebrospinal fluid, urine, prostatic secretions, and sputum should be performed for early diagnosis and appropriate therapy.