REPORT OF A CASE
A 58-year-old man with a history of angina and glucose intolerance had a nonhealing, nonpruritic left forearm plaque that had slowly enlarged over a 6-month period (Fig 1). He denied any history of trauma at this site. He felt well otherwise and denied having a cough or headache. The lesion measured 4×5 cm, with a sharp border along the wristwatch band. The edematous, crusted, and pseudovesicular appearance suggested a variety of infectious and inflammatory diagnoses. The clinical differential diagnosis included acute neutrophilic dermatosis, blastomycosis, and atypical mycobacteria infection. A skin biopsy was performed, the specimen revealing marked epidermal hyperplasia, papillary edema, and numerous yeasts without inflammation (Figs 2 and 3). A fungal culture of the lesion yielded Cryptococcus neoformans. A chest roentgenogram showed no infiltrate or focal lesions, the complete blood cell count showed normal neutrophil and lymphocyte counts, the blood chemistry findings were normal, and
Feldman SR, Fleischer AB, Resnick SD. Fluconazole Treatment of Cutaneous Cryptococcosis. Arch Dermatol. 1992;128(8):1045–1046. doi:10.1001/archderm.1992.01680180039003
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