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Arch Dermatol. 2006;142:921.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Diagnosis: Cryptococcosis with previously undiagnosed HIV infection.

MICROSCOPIC FINDINGS AND CLINICAL COURSE

A skin biopsy specimen from the lesion on the patient's neck showed a heavy infiltration of macrophages within the dermis, with overlying ulceration. The results of acid-fast bacilli stains were negative. Within the macrophages, there were numerous round organisms with occasional budding forms. The organisms measured 5 to 15 µm in diameter. The cell walls stained with periodic acid–Schiff (Figure 4), and the capsule stained with alcian blue. Cryptococcus neoformans was therefore diagnosed.

Figure appears in full text version. Figure 4.

In view of this unusual presentation, especially in an "immunocompetent" individual, underlying HIV infection was suspected. Our patient had a positive HIV test result, with a CD4 cell count of 23/µL (reference range, 500-1500/µL) at diagnosis. Further investigation revealed normal findings on chest radiography, and analysis of a sample of cerebrospinal fluid showed that the protein level was elevated (0.6 g/L [reference range. 0.2-0.4 g/L]), but no organisms were found within the fluid. . . . [Full Text of this Article]

DISCUSSION

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Arch Dermatol. 2006;142(7):921.
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