A 47-year-old Caucasian man comes to a homeless clinic with complaints of a skin rash for the past two weeks. He was diagnosed with HIV infection 10 years ago, and is currently on antiretroviral therapy. His last CD4 count two months ago was 100/cu. mm. He admits that he has been very erratic with his medications and follow-up visits with his primary care physician due to insurance reasons. He was recently hospitalized and treated for some fungal infection, but he does not know the details of his hospitalization. He does not have his discharge papers with him. Examination of his skin shows multiple small papules with central umbilication over his trunk and upper thighs. These lesions are covered with a hemorrhagic crust.
Which of the following is the diagnostic method of choice in this patient?
A. Blood cultures
B. Microscopic examination of scrapings from the lesion
C. Biopsy of the lesion
D. Antigen testing
E. India-ink preparation
this guy has C. immitis
biopsy of the lesion
Once the diagnosis of cutaneous cryptococcosis is suspected, it is imperative to perform a biopsy and a histopathologic examination to confirm the diagnosis. Histopathological examination usually reveals a granulomatous inflammatory reaction with multinucleated giant cells, histiocytes, lymphocytes, neutrophils, and plasma cells with numerous yeast-like organisms present both in the free spaces and within the histiocytes and giant cells. Special stains such as Periodic Acid Schiff and Gomori's methenamine silver nitrate are commonly employed to identify the organism in the biopsy specimen.
mtb pg 27 show for dx of cryptococcosis :LP- Idia ink- and the most accurate test crypt antigen test with 95% sensit and spec
aceinhibitor.
mtb is talking about particularly "cryptococcosis meningitis".
ques is realted to cutaneous cryptococcus, early menifeation of systemic crptoccosis.
that; why after lesion biosy if it is positive, it is advised to look for other work ups:
-- crytoccal antigen in csf and serum
--india ink in csf
-- blood n csf culture
--- cxy
it's from uw explanation.
hope now it's clear.
thank you meti :: you are right , so it is actually the same cryp neoforman which causes pulmonary by inhalation and can become dissiminated hematologicaly to meninges ,kidney or skin which subseq give mening, kidney and cutanous inf and you are right for the cutanous form skin bpx and cx is the dx modalty