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Primary cutaneous mixed infection with Cryptococcus uniguttulatus and Mycobacterium tuberculosis

Summary

A 43-year-old man had persistent facial skin lesions for seven years that initially appeared to be fungal infection caused by Cryptococcus uniguttulatus. Standard antifungal treatments failed to completely cure the condition. Advanced genetic testing revealed the lesions were actually caused by two simultaneous infections: the fungus and tuberculosis bacteria. Once both infections were properly identified and treated with appropriate medications, the skin lesions finally healed.

Background

Cutaneous mixed infections involving multiple pathogens present significant diagnostic and therapeutic challenges. Cryptococcus uniguttulatus is an uncommon pathogenic species that rarely causes primary cutaneous infections, and cutaneous tuberculosis accounts for only 1-1.5% of extrapulmonary tuberculosis cases.

Objective

To report the first documented case of concurrent cutaneous infection caused by Cryptococcus uniguttulatus and Mycobacterium tuberculosis and highlight the importance of comprehensive diagnostic approaches in identifying complex infections.

Results

Initial culture identified C. uniguttulatus, but treatment with itraconazole and amphotericin B did not achieve complete resolution. Real-time PCR and NGS revealed concurrent M. tuberculosis infection with 8576 reads for M. tuberculosis and 3103 reads for Cryptococcus species. Following antituberculosis combination therapy, significant improvement of skin lesions was achieved.

Conclusion

This case represents the first reported instance of cutaneous C. uniguttulatus infection and mixed cutaneous infection involving both Cryptococcus and Mycobacterium species. Molecular diagnostic methods including NGS and real-time PCR are essential for identifying complex mixed infections that may be missed by conventional culture techniques.
  • Published in:BMC Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 40038591, DOI: 10.1186/s12879-025-10667-2
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