Cryptococcal cellulitis in a heart transplant recipient.

Cryptococcosis is an invasive fungal infection most often caused by the encapsulated yeasts Cryptococcus neoformans and Cryptococcus gattii. C neoformans is the major pathogenic member of the genus, thought to account for approximately 80% of isolates worldwide, and is found in pigeon droppings, soil, and rotting vegetation.1 The incidence in the United States is approximately 5 cases per 100,000.2 However, the global burden is much more significant, with more than 1 million new cases and more than 600,000 deaths a year.3Most patients with cryptococcosis are immunocompromised because of HIV infection, immunosuppressive therapy, or malignancy. Although cryptococcal infections begin in the lungs via inhalation of the basidiospore, the classical clinical manifestation is meningoencephalitis. Nonmeningeal, nonpulmonary symptoms are less common and generally reflect disseminated disease. Cutaneous manifestations are seen in approximately 15% of patients with systemic cryptococcosis and can have a variety of presentations, including papules, plaques, and ulcers.4 Here we present an uncommon case of cutaneous cryptococcosis presenting as cellulitis in a heart transplant recipient.