In April 2012 an 88-year-old woman, who was receiving oral
prednisolone (15 mg/day) for the treatment of chronic inflammatory demyelinating
polyneuropathy, was admitted to our hospital with suspected
pneumonia. The patient was diagnosed with pulmonary
cryptococcosis based on the findings from chest radiography and computed of tomographic imaging and observation of a high cryptococcal
antigen titer. The general condition of the patient, including her
fever, improved after initiation of an
intravenous infusion of
fluconazole (200 mg/day). However, the
skin ulcers on all the limbs, which were present at the time enlarged since her admittance, were found to have rapidly enlarged. The patient underwent a detailed examination by a dermatologist.
Skin ulcers measuring 4 × 6 cm on the dorsal surface of the left hand and understood without reporting 2 × 3 cm on the left thigh were noted, and she was diagnosed as having cutaneous
cryptococcosis based on the results of skin biopsy, direct microscopic examination of
pus, and mycological culture. For treatment of the
skin ulcers,
fluconazole was administered by
intravenous infusion at 200 mg/day for 7 days. The treatment was then changed to oral
itraconazole (200 mg/day). However, after 1 week, the patient exhibited a liver disorder, and the treatment was switched back to oral
fluconazole (200 mg/day). After 2 months of treatment, the
ulcers began to diminish. Thus, we believe that deep mycosis, including cutaneous
cryptococcosis, should be considered during differential diagnosis if the patient is either elderly or undergoing
corticosteroid/
immunosuppressant therapy and has an
ulcer.