consolidation. If CNS disease is present, induction should be
continued until CNS is sterile. Surgical excision of pulmonary
or cutaneous cryptococcus remains a controversial treatment
modality that is sometimes used in cases of anti-fungal
inefficacy or severe anti-fungal side effects (ie, nephropathy
from amphotericin).
Surgical removal of pulmonary or skin lesions is currently
limited to case reports, with no published prospective studies.
There have been several published cases of relapse-free
survival in patients who had undergone surgical intervention
along with anti-fungal therapy for PCC. However, there have
been reports of detrimental effects of surgical intervention,
as demonstrated in a case of PCC in a lung transplant patient
for whom surgical debridement of the skin was suspected to
have caused dissemination with CNS involvement.7,8 In the
absence of unifying data, we propose that the surgical removal
of cryptococcal lesions in the immunocompromised
host should be reserved for diagnostic purposes, cases
refractory to medical treatment, or solitary skin nodules
amenable to excision and primary closure.4,9
DISCLOSURES
None of the authors has declared any relevant conflicts of interest.
REFERENCES
- Wu G, Vilchez RA, Eidelman B, Fung J, Kormos R, Kusne S. Cryptococcal meningitis: an analysis among 5,521 consecutive organ transplant recipients. Transpl Infect Dis. 2002;4(4):183-188.
- Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis. 2001;7:375-381.
