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Background <p>Antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides are systemic autoimmune disorders affecting small- and medium-sized vessels. Cutaneous involvement is common, but diagnosis can be challenging when inflammatory lesions mimic infectious processes, particularly fungal infections such as cryptococcosis.</p> Case reports <p>We describe two female patients with ANCA-associated vasculitis who developed widespread cutaneous lesions with histopathological features resembling <i>Cryptococcus</i>. The first patient, a 57-year-old woman with p-ANCA MPO-positive vasculitis, presented with bullous and purpuric lesions along with pulmonary hemorrhage. Despite corticosteroids and cyclophosphamide, her disease course was complicated by multiorgan involvement and fatal outcome. The second patient, a 73-year-old woman with multiple comorbidities, developed vesicular and necrotic skin lesions initially misdiagnosed as disseminated herpes zoster. Histology demonstrated vasculitis with <i>Cryptococcus</i>-like changes, and after exclusion of fungal infection, immunosuppressive therapy led to complete resolution.</p> Discussion <p><i>Cryptococcus</i>-like histopathological changes have been reported in neutrophilic dermatoses, described as cryptococcoid Sweet syndrome. These yeast-like structures are thought to represent degenerating neutrophils rather than fungal organisms. Awareness of this rare finding is essential to avoid unnecessary antifungal therapy and ensure prompt initiation of immunosuppression.</p> Conclusion <p>Cutaneous <i>Cryptococcus</i>-like changes in ANCA vasculitis are rare but clinically significant. Accurate diagnosis requires integration of clinical context, microbiological testing, and histopathology. Early recognition is critical to guide appropriate management and improve patient outcomes.</p>

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Cutaneous lesions with Cryptococcus-like changes in the context of ANCA vasculitis: case reports and literature review

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • David Salinas,
  • Josefina Gallinal,
  • María Paz Poblete,
  • Macarena Armstrong,
  • Francisco Silva,
  • Claudio Karsulovic,
  • Carla Lazo,
  • Oriela Martinez

摘要

Background

Antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides are systemic autoimmune disorders affecting small- and medium-sized vessels. Cutaneous involvement is common, but diagnosis can be challenging when inflammatory lesions mimic infectious processes, particularly fungal infections such as cryptococcosis.

Case reports

We describe two female patients with ANCA-associated vasculitis who developed widespread cutaneous lesions with histopathological features resembling Cryptococcus. The first patient, a 57-year-old woman with p-ANCA MPO-positive vasculitis, presented with bullous and purpuric lesions along with pulmonary hemorrhage. Despite corticosteroids and cyclophosphamide, her disease course was complicated by multiorgan involvement and fatal outcome. The second patient, a 73-year-old woman with multiple comorbidities, developed vesicular and necrotic skin lesions initially misdiagnosed as disseminated herpes zoster. Histology demonstrated vasculitis with Cryptococcus-like changes, and after exclusion of fungal infection, immunosuppressive therapy led to complete resolution.

Discussion

Cryptococcus-like histopathological changes have been reported in neutrophilic dermatoses, described as cryptococcoid Sweet syndrome. These yeast-like structures are thought to represent degenerating neutrophils rather than fungal organisms. Awareness of this rare finding is essential to avoid unnecessary antifungal therapy and ensure prompt initiation of immunosuppression.

Conclusion

Cutaneous Cryptococcus-like changes in ANCA vasculitis are rare but clinically significant. Accurate diagnosis requires integration of clinical context, microbiological testing, and histopathology. Early recognition is critical to guide appropriate management and improve patient outcomes.