Primary cryptococcal tenosynovitis in a patient with rheumatoid arthritis

Here, we report a case of primary cryptococcal tenosynovitis and arthritis caused by worsened cellulitis in a patient with rheumatoid arthritis (RA) who had been taking methotrexate and leflunomide. The patient, injured during the soybean harvest, failed to respond to empirical antibiotic therapy for presumed bacterial cellulitis on the dorsum of the right hand. An operative procedure was performed. Cryptococcocal tenosynovitis was diagnosed upon histopathological examination of the lesion. Treatment with 400 mg of fluconazole daily for 3 months led to the complete disappearance of skin lesions, with slight limitation of finger extension. The patient was examined continuously for 2 years, and there was no evidence of relapse or dissemination to other organs. This case indicates that primary cryptococcal skin and soft tissue infections must be included in the differential diagnoses of antibioticsrefractory soft tissue infections, especially in immunocompromised patients.