J Korean Soc Surg Hand.  2017 Sep;22(3):208-213. 10.12790/jkssh.2017.22.3.208.

Cutaneous Cryptococcosis Caused by Intravenous Line in Patient with Rheumatoid Arthritis

• Ryu SM
• Yoon DH
• Chung KJ
• Choi JH
• Park SG

• KMID: 2391219
• DOI: http://doi.org/10.12790/jkssh.2017.22.3.208

Abstract

Primary cutaneous cryptococcosis is a fungal infection caused by Cryptococ cus neoformans which is frequently occurred in the immunosuppressed host. The treatment of primary cutaneous cryptococcosis is mainly fluconazole, and the prognosis is relatively good. We report a case of primary cutaneous cryptococcosis due to intravenous line on the left forearm after lumbar stenosis surgery in a patient with rheumatoid arthritis, who finally underwent second, fourth, and fifth ray amputation.

Keyword

Cryptococcosis; Rheumatoid arthritis; Intravenous injection; Fluconazole; Amputation; Surgical flap

MeSH Terms

Amputation
Arthritis, Rheumatoid*
Constriction, Pathologic
Cryptococcosis*
Fluconazole
Forearm
Humans
Immunocompromised Host
Injections, Intravenous
Prognosis
Surgical Flaps
Fluconazole

Figure

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  Fig. 1. (A) Preoperative photo. Large painful ulcerations and widespread cellulitis originated from intravenous line in the left forearm. (B) Intraoperative photo shows massive granulomatous tissues around extensor tendons and muscles.

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  Fig. 2. (A) Histopathologic examination shows multiple round spores in necrotic tissue (H&E stain, ×200). (B) PAS stain shows reddish round spores (PAS stain, ×200).

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  Fig. 3. (A) Intraoperative photo shows that skin and subcutaneous tissues were removed extensively above the fascias of extensor muscles due to progressive necrosis (one month after photographing Fig. 1). (B) Postoperative simple radiograph. After the second to fifth extensor tendons were removed, the interphalangeal joints were temporarily fixed with the Kirschner wires.

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  Fig. 4. Two months after orthopedic surgery, second ray was also amputated for wound healing. Local advancement flap was performed immediately.

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  Fig. 5. Eight months after orthopedic surgery. (A) The wound left hand was well healed, and the opposition of the thumb was possible. (B) Preservation of these 2 digits allowed to allow grasping large objects. (C) The wound of left forearm was also well healed. (D) Simple radiograph shows that second, fourth, and fifth rays were amputated.

Reference

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