Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities

BACKGROUND. Cryptococcal necrotizing fasciitis that is localized to the lower extremities is very rare. OBJECTIVE. We describe a case of a renal transplant recipient who presented with necrotizing fasciitis of the legs caused by Cryptococcus neoformans, a fungus that is rarely associated with this disease. METHODS. This is a case report with literature review. RESULTS. The patient was hospitalized, and the site of infection was debrided to the level of the periosteum. Cultures and histopathologic examination of biopsy material revealed an invasive deep-seated infection with a fungal organism that was consistent with C. neoformans. After 21 days on parenteral amphotericin B (Ambisome; Er-Kim Pharmaceuticals) treatment, the patient was switched to oral itraconazole (Itraspor; Janssen-Cilag Pharmaceuticals) 200 mg/day. He was discharged after 30 days of hospitalization with his wounds completely healed. He continued on oral fluconazole for a total course of 6 weeks. CONCLUSION. Systemic fungal infections continue to be an important cause of morbidity and mortality in transplant recipients. The insidious nature and atypical manifestations of these infections often delay diagnosis and therapy. In immunosuppressed patients, persistent fever that does not respond to antibacterial therapy should alert the physician to the possibility of fungal infection.