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Introduction
Patients infected with HIV are susceptible to many opportunistic fungal infections. Cryptococcosis is an opportunistic infection caused by a ubiquitous encapsulated yeast, Cryptococcus neoformans, present in soil, dust and pigeon excreta. The main route of infection is inhalation of small yeast forms which are aerosolized. The pulmonary infection is primary site and most frequently self-limited and may be asymptomatic [1]. It occurs in 6 to 13% of patients with acquired immunodeficiency syndrome (AIDS), when their CD4 lymphocyte count is below 200/cmm [2]. Currently, AIDS represents the most common risk factor and cryptococcosis at other sites follows dissemination from lungs. Most common recognized site of disseminated cryptococcosis is the central nervous system. Cutaneous cryptococcosis is rare (20%) and is a sign of dissemination and may precede life threatening disease by several weeks. The lesions may vary greatly in morphology and mimic molluscum contagiosum or penicillium marneffei. Other presentations include acneiform papules or pustules, tumors, plaques, abscess, cellulitis, purpura, draining sinus, ulcers, bullae, subcutaneous swelling, herpetiform lesions, violaceous lichenoid lesions, nodular eruption on chin, a warty tumor on foot, a pseudofolliculitis & cryptococcosis mimicking Kaposi sarcoma [1,3]. These lesions are an ominous sign as they are often the first presenting symptom of systemic disease.;
Case Report
A 38-year-old male presented with skin lesions over face, chest & back since 10days and was admitted in neurology ward with severe headache, vomiting and seizures of 1week duration. Patient was a known HIV seropositive since 3yrs. Patient was asymptomatic till he presented with above complaints. No history of similar complaints in the past. History of extramarital exposure – 5yrs back. No History of any chronic illness and patient did not have antiretroviral therapy. On Dermatological examination, multiple umbilicated papules and nodules present over face, front of the chest, upper back, upper arms & forearms (Fig. 1 [See PDF],2). Few lesions showed necrosis at the centre (Fig. 3 [See PDF]). Excoriations were seen. No lesions were seen over palms, soles, oral mucosa and genitals. There was no cervical or axillary lymphadenopathy. Systemic examination of nervous system was remarkably normal with no signs of meningeal irritation and neck stiffness, deep tendon reflexes were normal. There was no hepatosplenomegaly and lungs were apparently normal. Haematological and Biochemical investigations were within normal limits...