Objective:

To improve recognition of cutaneous cryptococcosis in kidney transplant recipients, particularly as an early manifestation of disseminated infection.

Approach:

• Case Report: Describes a 53-year-old man who developed early-onset disseminated Cryptococcus neoformans infection within 2 months of ABO-incompatible kidney transplantation, initially presenting with cellulitis-like skin findings.
• Literature Review: A systematic review conducted according to PRISMA guidelines identified published kidney transplant recipients with microbiologically and/or histopathologically confirmed cryptococcosis and documented cutaneous involvement.

Key Findings:

• Sixty-five studies comprising 72 kidney transplant recipients were included; with the present case, 73 patients were analyzed. Disseminated disease occurred in 49 of 73 patients (67.1%).
• Cutaneous lesions were the initial manifestation in 34 of 49 disseminated cases (69.4%), and cellulitis-like lesions were the most common cutaneous presentation, occurring in 36 of 73 patients (49.3%).
• Cutaneous cryptococcosis frequently mimicked bacterial cellulitis or erysipelas, contributing to misdiagnosis and delayed antifungal therapy.
• The reported patient developed disseminated C. neoformans infection shortly after ABO-incompatible kidney transplantation, with skin involvement as an initial manifestation.

Interpretation:

Cutaneous cryptococcosis in kidney transplant recipients is uncommon but clinically important because skin lesions may be an early sign of disseminated disease and can resemble bacterial skin and soft tissue infections. Recognition of these presentations may facilitate earlier diagnosis and appropriate evaluation for systemic involvement.

Limitations:

• The available evidence consists largely of published case reports and case series, limiting the ability to estimate incidence or establish causal associations.
• The risk of cryptococcosis specifically in ABO-incompatible kidney transplant recipients remains poorly defined, and evidence regarding the contribution of rituximab-associated B-cell depletion is limited.

Conclusion:

Cutaneous cryptococcosis should be considered in kidney transplant recipients with atypical or antibiotic-unresponsive cellulitis-like lesions, particularly because skin involvement may signal disseminated infection. Early recognition, skin biopsy, and evaluation for systemic disease are important for timely diagnosis and management.