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August 1992

Fluconazole Treatment of Cutaneous Cryptococcosis

Author Affiliations

Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC; University of North Carolina, Chapel Hill

Arch Dermatol. 1992;128(8):1045-1046. doi:10.1001/archderm.1992.01680180039003

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

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