Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition. Academic Article uri icon

Overview

abstract

  • An 87-year old Caucasian male with past medical history of rheumatoid arthritis (RA) and chronic kidney disease presents with left hand erythema, pain, tenderness, induration and edema. Clinically, these hand findings began proximal to the metacarpo-phalangeal joints and extended to the distal wrist. He was noted to have ipsilateral axillary lymph node enlargement but denied any constitutional signs or symptoms. Laboratory markers of inflammation were poor prognostic indicators due to relatively active RA, the use of chronic daily glucocorticoids and weekly adalimumab use. Oral antibiotics were administered with limited success leading to a skin biopsy which reported a hematogenously disseminated fungal panniculitis; cultures grew Cryptococcus neoformans, however, serum cryptococcal antigen was negative. With initial fluconazole treatment, skin findings and lymphadenopathy improved gradually over the next six months. However, the patient's improvement stagnated and his condition reverted back to the state of initial presentation.

publication date

  • November 22, 2013

Identity

PubMed Central ID

  • PMC4470148

Scopus Document Identifier

  • 84856577795

Digital Object Identifier (DOI)

  • 10.3201/eid1801.111190

PubMed ID

  • 26237147

Additional Document Info

volume

  • 2

issue

  • 4