Resident Rounds Part III: Case Report: Fatal Cryptococcal Panniculitis in a Lung Transplant Recipient

May 2015 | Volume 14 | Issue 5 | Features | 519 | Copyright © May 2015


Bobby Y. Reddy MD,a Sheila Shaigany BS,a Lawrence Schulman MD,b and Marc E. Grossman MD FACPa

aDepartment of Der matology, Columbia University Medical Center, New York, NY
bDepartment of Medicine, Columbia University Medical Center, New York, NY

table 1
table 2
festation of disseminated cryptococcosis in SOT patients, with multiple other morphologies described in disseminated disease.4 Cryptococcal panniculitis is a rare entity reported in only 13 SOT recipients (12 renal, 1 heart), all males, with most presenting with painful lower extremity involvement; cryptococcal panniculitis has not been previously reported in a lung transplant patient (Table 1).5
The Infectious Diseases Society of America (ISDA) and the American Society of Transplantation recommend treatment of cutaneous cryptococcosis as if CNS disease is present.
Treatment consists of the following 3 stages:
  1. Induction: liposomal amphotericin B and 5-flucytosine for 2 weeks;
  2. Consolidation: high-dose fluconazole (400 mg/day to 800 mg/day) for 8 to10 weeks;
  3. Maintenance: low-dose fluconazole (200 mg/day) for 6 to 12 months.6
A lumbar puncture should be performed after induction to ensure eradication of CNS disease, prior to proceeding to
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