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Primary cutaneous mixed infection with Cryptococcus uniguttulatus and Mycobacterium tuberculosis

Summary

A 43-year-old man had a persistent facial rash that didn’t improve with standard antifungal treatments. Doctors initially found a fungal infection called Cryptococcus uniguttulatus using culture tests. However, advanced molecular testing (DNA sequencing) revealed he also had a tuberculosis infection in the same skin lesion. Once both infections were treated with appropriate medications, the patient’s rash finally improved. This case shows that sometimes people can have multiple infections at the same location and that newer diagnostic methods are important for finding these hidden infections.

Background

Cutaneous mixed infections involving multiple pathogens present significant diagnostic and therapeutic challenges. Cryptococcus uniguttulatus rarely causes primary cutaneous infections, and cutaneous tuberculosis is uncommon. This case represents the first documented concurrent cutaneous infection caused by both pathogens.

Objective

To report and analyze the first documented case of concurrent cutaneous infection caused by Cryptococcus uniguttulatus and Mycobacterium tuberculosis in an immunocompetent individual, highlighting diagnostic and therapeutic challenges.

Results

Histopathological examination revealed fungal organisms and granulomas. Fungal culture identified C. uniguttulatus. Despite initial treatment with itraconazole and amphotericin B, complete resolution was not achieved. Real-time PCR and NGS revealed concurrent M. tuberculosis infection (8576 reads for M. tuberculosis and 3103 reads for Cryptococcus species). Combination anti-tuberculosis therapy led to significant improvement.

Conclusion

This case underscores the importance of comprehensive diagnostic approaches, particularly molecular methods like NGS and real-time PCR, in identifying complex mixed infections that may be missed by conventional culture techniques. The necessity of considering mixed infections in cases refractory to initial therapy is emphasized, even in immunocompetent individuals.
  • Published in:BMC Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 40038591, DOI: 10.1186/s12879-025-10667-2
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