A 53-year-old retired man living in rural areas.
It was diagnosed 10 years ago with inflammatory bowel disease, which is controlled only with high doses of steroids.
Two years earlier he had been admitted to the Intensive Care Unit due to sepsis of intestinal origin with multiorgan failure; since then he has been on regular hemodialysis since there is no functional recovery.
Renal biopsy showed tubulointerstitial nephropathy.
One month before admission, the patient presented skin lesions, erythematous, over indurated, pruritic and painful areas, on the back of the right foot and internal face of the thighs, with bad response to empirical treatment (AU)
A skin biopsy was performed and reported as cryptosis.
Direct examination with Chinese ink and Gram stain showed abundant spherical, large yeasts with marked and encapsulated gemination.
Lead-formin culture, urease positive, compatible with cryptococcal neoformans variety neoformans.
Positive serum cryptolatex 1/2048.
Pulmonary and neurological involvement was ruled out by computed tomography and lumbar puncture.
1.
We started treatment with voriconazole 200 mg/12 hours, presenting within 10 days a marked alteration of liver tests (total bilirubin: 9.59 mg/dl; direct amphotericin B-glutpyramic acid: 226 mg/dl; transaminase
In addition, the prednisone dose was decreased.
After 2 weeks, the lesions improved considerably, with almost complete disappearance of the ulcerations and normalization of liver tests.
