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J. Clin. Med. 2013, 2(4), 260-263; doi:10.3390/jcm2040260
Communication

Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition

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Received: 8 October 2013; in revised form: 1 November 2013 / Accepted: 15 November 2013 / Published: 22 November 2013
View Full-Text   |   Download PDF [162 KB, uploaded 22 November 2013]
Abstract: An 87-year old Caucasian male with past medical history of rheumatoid arthritis (RA) and chronic kidney disease presents with left hand erythema, pain, tenderness, induration and edema. Clinically, these hand findings began proximal to the metacarpo-phalangeal joints and extended to the distal wrist. He was noted to have ipsilateral axillary lymph node enlargement but denied any constitutional signs or symptoms. Laboratory markers of inflammation were poor prognostic indicators due to relatively active RA, the use of chronic daily glucocorticoids and weekly adalimumab use. Oral antibiotics were administered with limited success leading to a skin biopsy which reported a hematogenously disseminated fungal panniculitis; cultures grew Cryptococcus neoformans, however, serum cryptococcal antigen was negative. With initial fluconazole treatment, skin findings and lymphadenopathy improved gradually over the next six months. However, the patient’s improvement stagnated and his condition reverted back to the state of initial presentation.
Keywords: panniculitis; Cryptococcus neoformans; adalimumab; TNF-α inhibitor; fluconazole panniculitis; Cryptococcus neoformans; adalimumab; TNF-α inhibitor; fluconazole
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MDPI and ACS Style

Gomes, R.M.; Cerio, D.R.; Loghmanee, C.; McKinney, J.; Patel, M.; Miraglia, J.; Yousef-Bessler, M.; Zippin, J.H.; Schuetz, A.N.; Pinho, P.B. Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition. J. Clin. Med. 2013, 2, 260-263.

AMA Style

Gomes RM, Cerio DR, Loghmanee C, McKinney J, Patel M, Miraglia J, Yousef-Bessler M, Zippin JH, Schuetz AN, Pinho PB. Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition. Journal of Clinical Medicine. 2013; 2(4):260-263.

Chicago/Turabian Style

Gomes, Rui M.; Cerio, Dean R.; Loghmanee, Cyrus; McKinney, Justin; Patel, Mili; Miraglia, Janeen; Yousef-Bessler, Manal; Zippin, Jonathan H.; Schuetz, Audrey N.; Pinho, Paulo B. 2013. "Cutaneous Cryptococcoma in a Patient on TNF-α Inhibition." J. Clin. Med. 2, no. 4: 260-263.


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