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E. Ladoyanni, M. Pereira, K. Struthers, K. Chen, G. Haydon, D. Mutimer, E. Elias, A. Ilchyshyn, Disseminated Cryptococcus infection in a liver‐transplant recipient presenting with a chronic scalp eruption, Clinical and Experimental Dermatology, Volume 33, Issue 5, 1 September 2008, Pages 655–656, https://doi.org/10.1111/j.1365-2230.2008.02781.x
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Conflict of interest: none declared.
A 27‐year‐old man presented with a 10‐week history of a discharging crusted eruption on the right scalp. Swab cultures had repeatedly grown Staphylococcus aureus and he had received a total of four courses of systemic antibiotics. Four years previously, he had undergone an orthotopic liver transplant (OLT) for fulminant non‐A, non‐B hepatitis; his regular drug treatment consisted of sirolimus, tacrolimus and calcium folinate.
Clinical examination (Fig. 1a,b) revealed a thick yellow crust covering most of the right scalp. Once the crust was removed, soft plaques and multiple satellite papules were seen. Similar lesions were present on the left temple and nose. A palpable right cervical lymph node was noted.
A skin biopsy was taken, which showed foamy macrophages and numerous fungal spores replacing the normal architecture (Fig. 2). Cultures from the skin biopsy grew Cryptococcus neoformans. Further investigations in hospital confirmed the presence of a serum cryptococcal antigen titre of 1 : 1600, but blood and cerebrospinal fluid cultures were negative. A thoracic computed tomography (CT) scan (Fig. 3) demonstrated a soft‐tissue lesion, 31 mm in size, in the apical segment of the right upper lobe, a further well‐defined 17 mm nodule in the left upper pole, and multiple smaller nodules scattered throughout the lung. A CT‐guided lung biopsy was taken, which revealed a cryptococcal infection with surrounding fibrosis.
