Primary Cutaneous Cryptococcosis during Therapy with Methotrexate and Adalimumab

Primary cutaneous infection with Cryptococcus neoformans is uncommon, but can occur following an inoculation injury to the skin. Tumor necrosis factor-alpha (TNF-?) is important in the immune response to Cryptococcus, and patients taking inhibitors of TNF-? may have increased susceptibility to cryptococcal infection. We report a case of primary cutaneous cryptococcosis in a patient taking adalimumab, methotrexate, and hydroxychloroquine for rheumatoid arthritis.