SHM Converge Scientific Abstract ePoster Gallery-Cutaneous Cryptococcus Causing Disseminated Cryptococcosis With a Prolonged Indwelling Line

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This case describes a 58-year-old man with multiple risk factors for infection, including COPD, poorly controlled diabetes, and hepatitis C–related cirrhosis, who was hospitalized for severe respiratory failure requiring ECMO. His prolonged course was complicated by empyema, renal failure requiring continuous renal replacement therapy through a femoral central line, and septic deterioration after the line had been in place for more than a month.<br /><br />Despite a broad infectious workup that was initially negative, the patient developed umbilicated papules around the femoral line site, raising concern for a fungal skin infection. Fungal blood cultures were obtained, and he was started empirically on fluconazole. Cultures later grew Cryptococcus neoformans, prompting escalation to amphotericin B and flucytosine. A lumbar puncture showed cryptococcal antigen in the cerebrospinal fluid at a high titer (1:2560), confirming disseminated cryptococcosis with central nervous system involvement.<br /><br />The presentation was notable because the cutaneous lesions appeared localized around the catheter site, and prior bronchoalveolar lavage studies had been negative, supporting the idea of primary cutaneous cryptococcosis associated with the prolonged femoral line rather than primary pulmonary disease. The authors suggest that Cryptococcus may have formed a biofilm on the catheter in the setting of immunocompromise, leading to bloodstream spread and dissemination.<br /><br />The patient died before skin biopsies could be obtained or antifungal therapy completed. The report emphasizes that prolonged central line placement increases the risk of line-associated bloodstream infection and that suspicious skin lesions with sepsis and negative bacterial studies should prompt strong suspicion for fungal infection, including Cryptococcus. Early fungal blood cultures, CSF testing, and skin biopsy can help confirm the diagnosis and enable timely treatment.

Asset Subtitle

Niyati Patel

Meta Tag

Author List Abhinav Karan, Anvit Reddy, Jorge Verdecia, Niyati Patel

Category Clinical Vignettes

Concept Cryptococcus neoformans

Concept Primary cutaneous cryptococcosis

Concept Disseminated Cryptococcosis

Concept Immunocompromised State

Concept Central Nervous System

Distinguished Non-Finalist

Presenter Organization Unviersity of Florida- Jacksonville

Presenting Author Niyati Patel

Track Adult

Keywords

Cryptococcus neoformans

disseminated cryptococcosis

central line infection

femoral catheter

cutaneous cryptococcosis

fungal bloodstream infection

cryptococcal meningitis

ECMO

immunocompromised host

biofilm formation

Cryptococcus neoformans

Primary cutaneous cryptococcosis

Disseminated Cryptococcosis

Immunocompromised State

Central Nervous System