Cryptic Secret behind an Ulcer: A Rare Case of Primary Localized Cutaneous Cryptococcosis

Cutaneous cryptococcosis is an infection caused by an encapsulated yeast Cryptococcus neoformans , which can be classified as primary or secondary depending on route of infection. The disease can also be classified as localized cutaneous cryptococcosis or cutaneous manifestation of disseminated cryptococcosis based on extent of skin involvement and visceral manifestations. Cutaneous cryptococcosis primarily localized to the skin with no visceral lesions or a history of trauma is referred to as localized cutaneous cryptococcosis. Here, we report the case of a 40-year-old immunocompromised male patient presented with a 3-month history of a solitary painful nonhealing ulcer over the left buttocks region. Histopathology sections showed capsulated yeast organisms within macrophages and additional culture evidence proved the diagnosis of cutaneous cryptococcosis. In an immunocompromised individual, although the disseminated form is more common, here, we report a very rare occurrence of localized primary cutaneous cryptococcosis in a solid-organ recipient. This case is also rare in terms of no preexisting trauma or primary inoculation being present prior to the onset of cutaneous lesions.