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Three cases of systemic candidiasis presenting as bullous skin lesion
( Byeong Jin Park ) , ( Su Jin Oh ) , ( Jae Min Shin ) , ( Eun Jin Kim ) , ( Jeong Eun Kim ) , ( Joo Yeon Ko ) , ( Young Suck Ro )
UCI I410-ECN-0102-2017-510-000108516
This article is 4 pages or less.

Systemic candidiasis is a relatively frequent and serious complication among immunocompromised patients. Cutaneous lesions that develop in patients with systemic candidiasis are usually 0.5 to 1.0 cm-sized erythematous papulonodules and a few cases of ecthyma gangrenosum and folliculitis-like lesions have been described. However, blister formation in patients with systemic candidiasis has been rarely reported. Candida albicans accounts for most cases of candida fungemia, but cases with cutaneous involvement are mainly caused by Candida tropicalis (C. tropicalis), which has ability to rapidly disseminate and causes higher mortality than other species. We experienced systemic candidiasis manifested as localized bullous skin lesion in three immunocompromised patients. Histopathologic examination from the bullous skin lesions showed multiple yeasts or pseudohyphae in the epidermis or deep dermis. Fungal culture was performed and C. tropicalis was identified in blood sample and skin lesion in all cases. In one patient, general health status and skin lesions gradually improved with systemic antifungal agents but the others had fatal courses. Therefore, fungal infection should be considered as a differential diagnosis if any bullous skin lesion of unexplained etiology occurs in immunocompromised patients and prompt skin biopsy combined with culture is needed to achieve proper diagnosis and treatment.

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