A rare case of cutaneous Papiliotrema ( Cryptococcus ) laurentii infection in a 23-year-old Caucasian woman affected by
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BRIEF REPORT
A rare case of cutaneous Papiliotrema (Cryptococcus) laurentii infection in a 23-year-old Caucasian woman affected by an autoimmune thyroid disorder with hypothyroidism J. Intra 1
&
C. Sarto 2 & P. Brambilla 2
Received: 17 April 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In recent years, the frequency of infections due to saprophytic fungi has increased. Cryptococcus laurentii, recently classified as Papiliotrema laurentii, is responsible for fungemia, meningitis, and superficial infections. Here, we report the first case of cutaneous Papiliotrema (Cryptococcus) laurentii infection in a 23-year-old Caucasian woman affected by an autoimmune thyroiditis with hypothyroidism. Impairments of the immune system are often associated with unusual fungal infections, which cannot be neglected. The isolate strain was susceptible to Amphotericin B while resistant to fluconazole, itraconazole, voriconazole, and terbinafine. The patient was successfully treated with Amphotericin B. Keywords Papiliotrema (Cryptococcus) laurentii . Cutaneous infection . MALDI-TOF . Autoimmune thyroid disease
Introduction Papiliotrema laurentii, previously known as Cryptococcus laurentii, is a basidiomycetous encapsulated yeast which was until recently considered to be a saprophytic and nonpathogenic microorganism [1–3]. It is widely isolated from several types of environments and, particularly, it is found in fecal samples of feral pigeons [2]. However, human infections caused by Papiliotrema (Cryptococcus) laurentii, i.e., skin lesions and fungemia, have been increasingly documented in immunocompromised patients, especially individuals with AIDS or undergoing immunosuppressive therapy, and only rarely in immunocompetent subjects [1–6]. The integumentary and endocrine systems are correlated through several complex mechanisms. In some cases, significant dermatologic diseases are due to endocrinopathies, such * J. Intra [email protected] 1
Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, Monza and Brianza, Italy
2
Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, Desio Hospital, via Mazzini 1, 20833 Desio, Monza and Brianza, Italy
as disorders of the hytpothalamic-pituitary axis, thyroid glands, pancreas, adrenal glands, and androgen excess [7]. Hypothyroidism is characterized by elevated thyroidstimulating hormone (TSH) with low or normal free thyroxine (FT4) serum levels. In individuals affected by hypothyroidism, the skin appears thin, dry, and rough with a reduced sebum secretion [7]. These features are most probably correlated to an increased frequency of mycotic infections [8–11]. Here, we report a case of cutaneous infections caused by Papiliotrema (Cryptococcus) laurentii in a 23-year-old Caucasian woman diagnosed with autoimmune thyroiditis.
Case report On 18 No
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