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Klin Padiatr 2015; 227(01): 41-44
DOI: 10.1055/s-0034-1387775
Case Report
© Georg Thieme Verlag KG Stuttgart · New York

Primary Cutaneous Cryptococcosis in an Eight-year-old Immunocompetent Child: How to Treat?

Primäre kutane Kryptokokkose bei einem 8-jährigen immungesunden Jungen: Wie behandeln?
D. Lenz
1   Heidelberg University Hospital, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
2   University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Freiburg, Germany
,
J. Held
3   University Medicine Erlangen, Clinical Microbiology, Immunology and Hygiene, Institute of Microbiology, Erlangen, Germany
4   University Medical Center Freiburg, Department of Medical Microbiology and Hygiene, Freiburg, Germany
,
S. Goerke
5   University Medical Center Freiburg, Department of Surgery, Division of Plastic and Hand Surgery, Freiburg, Germany
,
D. Wagner
6   University Medical Center Freiburg, Department of Medicine, Division of Infectious Diseases and Travel Medicine, Freiburg, Germany
7   University Medical Center Freiburg, Center for Chronic Immunodeficiency, Freiburg, Germany
,
K. Tintelnot
8   Robert Koch-Institute, Reference laboratory for cryptococcosis, scedosporiosis and imported systemic mycoses, Berlin, Germany
,
P. Henneke
2   University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Freiburg, Germany
7   University Medical Center Freiburg, Center for Chronic Immunodeficiency, Freiburg, Germany
,
M. Hufnagel
2   University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Freiburg, Germany
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Publikationsdatum:
07. Januar 2015 (online)

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Abstract

Here we report on a case of primary cryptococcal skin infection in an immunocompetent 8-year-old boy. The infection first manifested itself as a subcutaneous abscess around the proximal joint of his right thumb after a minor injury from contact with a thorny shrub. After surgical incision and drainage was performed, Cryptococcus neoformans var. neoformans was the only pathogen cultured from the lesion. An agglutination test for the capsular antigen in serum displayed negative results and the immunological work-up revealed no underlying immunodeficiency. A “watch and wait” strategy — one without systemic antifungal treatment — was adopted and this resulted in uneventful healing. In summary, primary cryptococcal skin infections in immunocompetent hosts may be managed successfully by surgical treatment in combination with careful clinical follow-up. This approach may help avoid unnecessary antimicrobial treatments.

Zusammenfassung

Wir berichten über den Fall einer primären Hautinfektion durch Kryptokokken bei einem 8-jährigen immunkompetenten Jungen. Nach einer Verletzung in einem Dornengestrüpp manifestierte sich diese als subkutaner Abszess des rechten palmaren Daumenballens. Nach chirurgischer Inzision und Drainage konnte Cryptococcus neoformans var. neoformans als einziger Krankheitserreger aus dem Drainagesekret kultiviert werden. Ein Agglutinationstest für das Kapsel-Antigen im Serum blieb negativ wie auch Untersuchungen hinsichtlich einer systemischen Infektion oder einer zugrundeliegenden Immundefizienz. Wir verfolgten daraufhin eine abwartende („wait and watch“)-Strategie bei primärer kutaner Kryptokokkose ohne systemische antimykotische Therapie. Diese führte zur vollständigen Genesung. Eine primäre kutane Kryptokokkose beim immungesunden Patient kann durch alleinige chirurgische Therapie mit anschließenden engmaschigen klinischen Verlaufskontrollen erfolgreich behandelt werden – ein Vorgehen, das hilft, unnötige antimikrobielle Behandlungen zu vermeiden.

Key words

cryptococcosis - cryptococcus neoformans var. neoformans - skin involvement - immunocompetence - capsule - treatment options

Schlüsselwörter

Kryptokokkose - Cryptococcus neoformans var. neoformans - Hautbeteiligung - Immunokompetenz - Kapsel - Behandlungsoptionen
 

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