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Cellulitis-like cutaneous cryptococcosis revealing disseminated infection in a kidney transplant recipient: a case report and systematic review.

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Τίτλος: Cellulitis-like cutaneous cryptococcosis revealing disseminated infection in a kidney transplant recipient: a case report and systematic review.
Συγγραφείς: Scaglione V; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy. Electronic address: vincenzo.scaglione@aopd.veneto.it., Melchiorri S; Department of Medicine, University of Padua, Padova, Italy., Cola M; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy., Chinellato A; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy., Cancian S; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy., Doria L; Department of Medicine, University of Padua, Padova, Italy., Piaserico S; Unit of Dermatology, Padua University Hospital, Padua, Italy., Fortarezza F; Surgical Pathology and Cytopathology Unit, Padua University Hospital, Padua, Italy., Furian L; Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, Padua University Hospital, Padua, Italy., Nalesso F; Nephrology, Dialysis and Transplantation Unit, Padua University Hospital, Padua, Italy., Castagliuolo I; Microbiology and Virology Unit, Padua University Hospital, Padua, Italy; Department of Molecular Medicine, University of Padua, Padua, Italy., Cattelan A; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy; Department of Molecular Medicine, University of Padua, Padua, Italy.
Πηγή: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2026 Oct; Vol. 171, pp. 109039. Date of Electronic Publication: 2026 Aug 11.
Τύπος έκδοσης: Journal Article; Systematic Review; Case Reports
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: Canada NLM ID: 9610933 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-3511 (Electronic) Linking ISSN: 12019712 NLM ISO Abbreviation: Int J Infect Dis Subsets: MEDLINE
Imprint Name(s): Publication: Hamilton, ON : Elsevier
Original Publication: Hamilton, ON : Decker, c1996-
Ιατρικοί όροι (MeSH): Kidney Transplantation*/adverse effects , Cryptococcosis*/diagnosis , Cryptococcosis*/drug therapy , Cryptococcosis*/microbiology , Cellulitis*/diagnosis , Cellulitis*/microbiology , Cellulitis*/drug therapy , Dermatomycoses*/diagnosis , Dermatomycoses*/drug therapy , Dermatomycoses*/microbiology, Cryptococcus neoformans/isolation & purification ; Antifungal Agents/therapeutic use ; Opportunistic Infections/diagnosis ; Opportunistic Infections/drug therapy ; Humans ; Male ; Female ; Adult ; Middle Aged ; Transplant Recipients
Περίληψη: Objectives: Cryptococcosis is an opportunistic infection increasingly recognized among kidney transplant recipients (KTR), often presenting with heterogeneous and misleading clinical manifestations. Cutaneous involvement is uncommon but may represent an early sign of disseminated disease, posing significant diagnostic challenges.
Methods: We report a case of disseminated Cryptococcus neoformans infection occurring shortly after ABO-incompatible kidney transplantation and performed a systematic review of the literature according to PRISMA guidelines. Published reports describing KTR with microbiologically and/or histopathologically confirmed cryptococcosis and documented cutaneous involvement were included. Clinical characteristics, diagnostic findings, treatment, and outcomes were extracted and analyzed.
Results: A total of 65 studies comprising 72 KTR were included; with the present case, 73 patients were analyzed. Disseminated disease was observed in (49/73, 67.1%) cases. Cutaneous lesions represented the initial manifestation in the majority of disseminated cases (34/49, 69.4%). The most frequent extracutaneous sites were the central nervous system (32/49, 65.3%), lungs (23/49, 46.9%), and bloodstream (19/49, 38.7%). Clinical presentation was highly heterogeneous, with cellulitis-like lesions being the most common (36/73, 49.3%), often leading to misdiagnosis and delayed antifungal therapy. Diagnosis relied primarily on skin histology, culture, and cryptococcal antigen testing. Most patients received amphotericin B-based regimens followed by azole-based consolidation therapy. Overall, 60/73 (82.2%) patients achieved clinical recovery, although mortality remained substantial, particularly in disseminated disease.
Conclusions: Among published cases, cutaneous cryptococcosis most commonly occurred in the setting of disseminated infection. Given its polymorphic presentation and frequent mimicry of bacterial skin infections, a high index of suspicion and prompt diagnostic evaluation are essential to ensure early recognition and improve clinical outcomes.
(Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: ABO-incompatible transplant; Antifungal susceptibility testing; Cryptococcal meningoencephalitis; Cryptococcus neoformans; Disseminated fungal infection; Fluconazole; Isavuconazole; Kidney transplant
Substance Nomenclature: 0 (Antifungal Agents)
Entry Date(s): Date Created: 20260811 Date Completed: 20260929 Latest Revision: 20261009
Update Code: 20261009
DOI: 10.1016/j.ijid.2026.109039
PMID: 42580510
Βάση Δεδομένων: MEDLINE
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  Data: Cellulitis-like cutaneous cryptococcosis revealing disseminated infection in a kidney transplant recipient: a case report and systematic review.
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  Data: <searchLink fieldCode="AU" term="%22Scaglione+V%22">Scaglione V</searchLink>; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy. Electronic address: vincenzo.scaglione@aopd.veneto.it.<br /><searchLink fieldCode="AU" term="%22Melchiorri+S%22">Melchiorri S</searchLink>; Department of Medicine, University of Padua, Padova, Italy.<br /><searchLink fieldCode="AU" term="%22Cola+M%22">Cola M</searchLink>; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Chinellato+A%22">Chinellato A</searchLink>; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Cancian+S%22">Cancian S</searchLink>; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Doria+L%22">Doria L</searchLink>; Department of Medicine, University of Padua, Padova, Italy.<br /><searchLink fieldCode="AU" term="%22Piaserico+S%22">Piaserico S</searchLink>; Unit of Dermatology, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Fortarezza+F%22">Fortarezza F</searchLink>; Surgical Pathology and Cytopathology Unit, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Furian+L%22">Furian L</searchLink>; Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Nalesso+F%22">Nalesso F</searchLink>; Nephrology, Dialysis and Transplantation Unit, Padua University Hospital, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Castagliuolo+I%22">Castagliuolo I</searchLink>; Microbiology and Virology Unit, Padua University Hospital, Padua, Italy; Department of Molecular Medicine, University of Padua, Padua, Italy.<br /><searchLink fieldCode="AU" term="%22Cattelan+A%22">Cattelan A</searchLink>; Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy; Department of Molecular Medicine, University of Padua, Padua, Italy.
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  Data: <searchLink fieldCode="JN" term="%229610933%22">International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases</searchLink> [Int J Infect Dis] 2026 Oct; Vol. 171, pp. 109039. <i>Date of Electronic Publication: </i>2026 Aug 11.
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  Data: <searchLink fieldCode="MM" term="%22Kidney+Transplantation%22">Kidney Transplantation*</searchLink>/<searchLink fieldCode="MM" term="%22Kidney+Transplantation+adverse+effects%22">adverse effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Cryptococcosis%22">Cryptococcosis*</searchLink>/<searchLink fieldCode="MM" term="%22Cryptococcosis+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Cryptococcosis%22">Cryptococcosis*</searchLink>/<searchLink fieldCode="MM" term="%22Cryptococcosis+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Cryptococcosis%22">Cryptococcosis*</searchLink>/<searchLink fieldCode="MM" term="%22Cryptococcosis+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+microbiology%22">microbiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Cellulitis%22">Cellulitis*</searchLink>/<searchLink fieldCode="MM" term="%22Cellulitis+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Dermatomycoses%22">Dermatomycoses*</searchLink>/<searchLink fieldCode="MM" term="%22Dermatomycoses+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Dermatomycoses%22">Dermatomycoses*</searchLink>/<searchLink fieldCode="MM" term="%22Dermatomycoses+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Dermatomycoses%22">Dermatomycoses*</searchLink>/<searchLink fieldCode="MM" term="%22Dermatomycoses+microbiology%22">microbiology</searchLink><br /><searchLink fieldCode="MH" term="%22Cryptococcus+neoformans%22">Cryptococcus neoformans</searchLink>/<searchLink fieldCode="MH" term="%22Cryptococcus+neoformans+isolation+%26+purification%22">isolation & purification</searchLink> ; <searchLink fieldCode="MH" term="%22Antifungal+Agents%22">Antifungal Agents</searchLink>/<searchLink fieldCode="MH" term="%22Antifungal+Agents+therapeutic+use%22">therapeutic use</searchLink> ; <searchLink fieldCode="MH" term="%22Opportunistic+Infections%22">Opportunistic Infections</searchLink>/<searchLink fieldCode="MH" term="%22Opportunistic+Infections+diagnosis%22">diagnosis</searchLink> ; <searchLink fieldCode="MH" term="%22Opportunistic+Infections%22">Opportunistic Infections</searchLink>/<searchLink fieldCode="MH" term="%22Opportunistic+Infections+drug+therapy%22">drug therapy</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Transplant+Recipients%22">Transplant Recipients</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: Cryptococcosis is an opportunistic infection increasingly recognized among kidney transplant recipients (KTR), often presenting with heterogeneous and misleading clinical manifestations. Cutaneous involvement is uncommon but may represent an early sign of disseminated disease, posing significant diagnostic challenges.<br />Methods: We report a case of disseminated Cryptococcus neoformans infection occurring shortly after ABO-incompatible kidney transplantation and performed a systematic review of the literature according to PRISMA guidelines. Published reports describing KTR with microbiologically and/or histopathologically confirmed cryptococcosis and documented cutaneous involvement were included. Clinical characteristics, diagnostic findings, treatment, and outcomes were extracted and analyzed.<br />Results: A total of 65 studies comprising 72 KTR were included; with the present case, 73 patients were analyzed. Disseminated disease was observed in (49/73, 67.1%) cases. Cutaneous lesions represented the initial manifestation in the majority of disseminated cases (34/49, 69.4%). The most frequent extracutaneous sites were the central nervous system (32/49, 65.3%), lungs (23/49, 46.9%), and bloodstream (19/49, 38.7%). Clinical presentation was highly heterogeneous, with cellulitis-like lesions being the most common (36/73, 49.3%), often leading to misdiagnosis and delayed antifungal therapy. Diagnosis relied primarily on skin histology, culture, and cryptococcal antigen testing. Most patients received amphotericin B-based regimens followed by azole-based consolidation therapy. Overall, 60/73 (82.2%) patients achieved clinical recovery, although mortality remained substantial, particularly in disseminated disease.<br />Conclusions: Among published cases, cutaneous cryptococcosis most commonly occurred in the setting of disseminated infection. Given its polymorphic presentation and frequent mimicry of bacterial skin infections, a high index of suspicion and prompt diagnostic evaluation are essential to ensure early recognition and improve clinical outcomes.<br /> (Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
– Name: Abstract
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
– Name: SubjectMinor
  Label: Contributed Indexing
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  Data: <i>Keywords: </i>ABO-incompatible transplant; Antifungal susceptibility testing; Cryptococcal meningoencephalitis; Cryptococcus neoformans; Disseminated fungal infection; Fluconazole; Isavuconazole; Kidney transplant
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