A man in his 20s presented to the dermatology department with a monthlong history of gradually progressing papules and nodules on the face, accompanied by fever, fatigue, and weight loss. On physical examination, multiple pink papules and umbilicated nodules were found on the face (Figure 1A). He had a 5-year history of HIV infection but self-discontinued his antiretroviral treatment due to treatment-related gastrointestinal and neurologic reactions 4 years prior. A biopsy specimen was taken for pathological examination (Figure 1B).
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Histopathology of a biopsy specimen showed numerous yeast forms surrounded by clear spaces (Figure 1B and Figure 2). The white blood cell count was 2040/μL, and the CD4-positive lymphocyte count was 2/μL (to convert both to ×109/L, multiply by 0.001). Multiple enlarged lymph nodes were found in the neck, axilla, groin, and posterior peritoneum. Capsular polysaccharide antigen of Cryptococcus neoformans in the serum and cerebrospinal fluid was positive. Fungal cultures of blood and cerebrospinal fluid were also identified as C neoformans. T-cell spot test for tuberculous was negative. A diagnosis of disseminated cryptococcosis was made. Liposomal amphotericin B and fluconazole were given to treat cryptococcosis, and antiretroviral therapy was restarted for HIV infection. The cutaneous symptoms resolved after 2 months.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Jianjun Qiao, MD, PhD, Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou, 310003 China (email@example.com).
Published Online: November 15, 2023. doi:10.1001/jamadermatol.2023.4162
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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