Cutaneous cryptococcal infection: Initial manifestation of acquired T-cell immunodeficiency due to malignant thymoma

Timothy McCann; Anar S. Patel; Neha Patel D; Deepali B. Sharath; Borna Mansouri; Cynthia Contreras

doi:10.18502/cmm.8.2.10334

Timothy McCann Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, Ohio, USA
Anar S. Patel Department of Infectious Diseases, Good Samaritan Hospital, Cincinnati, Ohio, USA
Neha Patel D Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, Ohio, USA
Deepali B. Sharath Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, Ohio, USA
Borna Mansouri Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, Ohio, USA
Cynthia Contreras Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, Ohio, USA

DOI: https://doi.org/10.18502/cmm.8.2.10334

Keywords: Cutaneous cryptococcosis, Cryptococcus neoformans, Thymic carcinoma, Type B3 thymoma

Abstract

Background and Purpose: Cryptococcosis is a known opportunistic infection. Thymomas are known to cause immune dysregulation. We describe an atypical case of cutaneous cryptococcosis in a patient with acquired T cell immunodeficiency that has been found to be secondary to a type B3 thymoma with progression to carcinoma.

Case report: A 63-year-old male presented with a chronic skin lesion confirmed as Cryptococcus neoformans on biopsy and an incidental mediastinal mass found during infectious work-up for the notable cluster of differentiation 4 (CD4)+ lymphopenia. This led to the diagnosis of a type B3 thymoma requiring resection. The cryptococcal lesion was treated successfully with azole therapy.

Conclusion: C. neoformans is an opportunistic infection rarely associated with isolated T cell immunodeficiency due to thymomas. A multidisciplinary approach and understanding of the pathogenicity of cryptococcus and the immunological effect of thymic dysfunction are paramount to diagnosis and treatment.