BACKGROUND: Cryptococcus neoformans has been known to cause infections in immunocompromised and immunocompetent patients. One of the most common sites of dissemination is cutaneous, but it usually presents as a single location where inoculation occurred and as a painless plaque.

CASE REPORT: We report the case of a 53-year-old female with history of ESRD presumably secondary to hypertensive nephrosclerosis who underwent deceased donor kidney transplant and was admitted for painful lower extremities and acute renal failure. Her physical exam was significant for diffuse patchy brawny plaques. A biopsy of her abdomen showed cryptococcosis and her blood cultures were positive for Cryptococcus neoformans. Despite treatment for cryptococcus and co-infection CMV, her renal failure continued to progress. She was referred for nephrectomy and taken off her immunosuppressive therapy. She then recovered fully and showed rapid improvement in her lab values.

CONCLUSIONS: Cutaneous manifestation of cryptococcosis has been well documented, but few cases have such diffuse manifestation and such rapid improvement of severe disease with treatment. Our case demonstrates continued difficulty treating the disease with co-infection of CMV and immunosuppressive therapy in such a severe case of cutaneous manifestations of disseminated Cryptococcus. Biopsy of cutaneous lesions remains the mainstay for diagnosis of disease, and blood cultures are needed to aid in diagnosis of dissemination.

Keywords: Cryptococcus, Cryptococcus neoformans, Kidney Transplantation, Opportunistic Infections