We report the case of a 68-year-old woman with
autoimmune hepatitis (AIH) who had
leg ulcers induced by disseminated
cryptococcosis. She had received
prednisolone for her AIH at 20 mg/day for maintenance. On the initial visit, she complained of a painful
ulcer that had round, shallow pockets with
erythema and erythematous subcutaneous indurations on the right thigh. Several metacarpophalangeal joints and wrist joints were swollen, with tenderness and stiffness in the morning for over 3 h. Her serum
rheumatoid factor was high. Since other autoimmune disorders such as
rheumatoid arthritis can present with AIH, it was necessary to distinguish it from
ulcers due to
rheumatoid arthritis, although the characteristic features of these
ulcers seemed to be different. A biopsy specimen from the erythematous skin showed globe-shaped organisms in the dermis and subcutaneous tissues;
vasculitis and phlebostasis were not observed. The results from computed tomography scans and sputum culture led to the diagnosis of disseminated
cryptococcosis. The administration of
fluconazole,
fosfluconazole, and
voriconazole for about 2 months improved the cryptococcal
pneumonia, but the size of the
skin ulcer enlarged. The administration was changed to
itraconazole, which reduced the size. Cryptococcal
infections occur more commonly in immunocompromised hosts, including patients under immunosuppressive therapies such as
corticosteroids. The possibility that the
skin ulcers in immunocompromised hosts may be caused by
cryptococcosis should be considered.