Primary Cutaneous Cryptococcosis Presenting as Flexor Tendon Sheath Infection in a Patient With Myelodysplastic Syndrome: A Case Report

Primary cutaneous cryptococcosis (PCC) is a rare clinical presentation, usually associated with traumatic inoculation of cryptococcal spores into the skin, and occurs in both immunocompetent and immunocompromised patients.We report a case of an 81-year-old man with a background of myelodysplastic syndrome (MDS), who developed cellulitis with clinical features of a flexor tendon sheath infection of his right middle phalanx following a splinter.He underwent multiple surgical debridements, including eventual amputation of his finger.Cryptococcus neoformans was isolated from culture of debrided tissues.In addition to surgical interventions, he was treated with oral itraconazole for two weeks, followed by fluconazole for nine weeks, resulting in a good clinical outcome.He did not develop respiratory or neurological symptoms and remained systemically well throughout.His serum cryptococcal antigen was also negative on two occasions.This case highlights the need to consider locally invasive PCC in aggressive cellulitis that does not respond to antibiotics or surgical debridement, especially in patients with an impaired immune response.