Cutaneous cryptococcosis in HIV patient: a diagnostic dilemma

Cutaneous cryptococcosis is an opportunistic infection commonly found in patients with immunosuppression, especially HIV/AIDS, hematological malignancy such as leukemia and lymphoma, diabetes mellitus, sarcoidosis, cancer chemotherapy, and solid organ transplant. The disease has also been occasionally reported in immunocompetent individuals. Although the burden of HIV/AIDS is high in Nigeria, cutaneous cryptococcosis is rarely found. It is caused by ubiquitous encapsulated basidiomycetes yeast-like fungi Cryptococcus neoformans and C. gattii. These two distinct species consist of five serotypes A, D, and AD as seen in C. neoformans, and serotype B and C are found with C. gattii. The emergence of cutaneous cryptococcosis can provide a window of opportunity for early clinical diagnosis and treatment of more devastating disease such as cryptococcal meningitis with its high mortality of 70-80%. So, physician should be aware of cutaneous cryptococcosis mimicking other cutaneous diseases like Kaposi sarcoma, molluscum contagiosum to help in early diagnosis and treatment. We report a rare case of female HIV patient with cutaneous cryptococcosis of the face, misdiagnosed as Kaposi sarcoma, and adverse drug reaction. At the time of this report, there was no evidence of any systemic disease. She was successfully treated with oral fluconazole monotherapy and to continue life-long oral fluconazole therapy. Patient is to be followed-up with regular physical examinations for any possible recurrence. Physicians should be well informed about many forms of clinical presentations and treatments of cutaneous cryptococcosis to reduce the burden of the disease especially in HIV/AIDS.