류마티스 관절염으로 장기간 Tacrolimus 복용중인 환자에서 발생한 전신성 효모균증

Abstract

Cryptococcosis is the infection caused by the encapsulated yeast Cryptococcus species, occuring most frequently in immunocompromised hosts. Cutaneous cryptococcosis occurs in 10~15% of disseminated cases and its clinical manifestation is variable. The patient was a 73-year-old female, who had been taking a tacrolimus 3 mg/day for 2 years due to rheumatic arthritis. She had an erythematous ulcerated lesion with elevated border on right shoulder and left back, and painful subcutaneous nodules on left chest. Histopathologic examination of skin showed typical spores with capsules in dermis and chest X-ray showed fungal ball in lung. She was successfully treated by systemic amphotericin B and fluconazole. Herein, we report a case of disseminated cryptococcosis with skin involvement during long-term tacrolimus therapy.