SHM Converge Scientific Abstract ePoster Gallery-Umbilicated Skin Papules in a Patient With Newly Diagnosed Hiv

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A 30-year-old man with newly diagnosed advanced HIV infection presented with 2 weeks of dyspnea, dry cough, and multiple umbilicated papules on the face, neck, and chest. His CD4 count was 13 cells/mm³ and HIV viral load was 207,000 copies/mL. Because the skin lesions resembled molluscum contagiosum, further evaluation was performed. Chest CT showed bilateral centrilobular ground-glass opacities with subpleural sparing. Serum cryptococcal antigen was strongly positive, and skin biopsy demonstrated budding yeasts consistent with Cryptococcus. Bronchoalveolar lavage also supported pulmonary cryptococcosis.<br /><br />Lumbar puncture showed a normal cerebrospinal fluid profile, including normal opening pressure, low white blood cell count, and normal protein and glucose, but CSF cryptococcal antigen was positive, confirming cryptococcal meningoencephalitis despite the absence of meningeal signs or headache.<br /><br />He was diagnosed with disseminated cryptococcosis involving the skin, lungs, and central nervous system. Treatment with 2 weeks of liposomal amphotericin B plus flucytosine was followed by oral fluconazole. At 6-week follow-up, his dyspnea had resolved and the skin lesions were improving.<br /><br />This case highlights that in patients with HIV, umbilicated papules may represent cutaneous cryptococcosis rather than molluscum contagiosum. Because skin lesions often indicate disseminated disease, lumbar puncture should be performed even when neurologic symptoms are absent. CSF indices can be normal in cryptococcal meningitis, so cryptococcal antigen testing and/or culture are essential for diagnosis.

Asset Subtitle

Hayato Mitaka

Meta Tag

Author List Hayato Mitaka

Category Clinical Vignettes

Concept Disseminated Cryptococcosis

Concept Cryptococcal Meningoencephalitis

Concept Central Nervous System Involvement

Concept Lumbar Puncture

Concept Cerebrospinal Fluid Antigen Test

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Hayato Mitaka

Track Adult

Keywords

HIV infection

disseminated cryptococcosis

cutaneous cryptococcosis

umbilicated papules

molluscum contagiosum

pulmonary cryptococcosis

cryptococcal meningoencephalitis

cryptococcal antigen

liposomal amphotericin B

flucytosine

Disseminated Cryptococcosis

Cryptococcal Meningoencephalitis

Central Nervous System Involvement

Lumbar Puncture

Cerebrospinal Fluid Antigen Test