Primary Cutaneous Cryptococcosis in a Patient With the Acquired Immunodeficiency Syndrome

To the Editor. —We report a case of cutaneous cryptococcosis in a homosexual man with the acquired immunodeficiency syndrome (AIDS). This case is interesting because cutaneous lesions represented the only manifestation of cryptococcosis and the first manifestation of AIDS. A 48-year-old homosexual man, seropositive for the human immunodeficiency virus since 1987 (stage III, scale of the Centers for Disease Control, Atlanta, Ga), had been receiving zidovudine therapy since May 1990. In June 1990, he was referred to our center with a crusted lesion on the scalp that had developed in about 1 month. After removal of the crust, a round ulcer with an irregular border was visible (Fig 1). Partial regression was obtained with oral and local antibiotic therapy in about 2 weeks, but, 1 month later, the primary ulcer enlarged, and several secondary ulcerated nodules appeared on the scalp, face, trunk, and upper limbs. Skin specimens stained with hematoxylin-eosin,