Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy - a case report.

BACKGROUND: Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature. CASE PRESENTATION: We reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis. CONCLUSION: Through this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving.

Community exposure to arsenic in the Mekong river delta, Southern Vietnam.

We examined the daily inorganic arsenic (i-As) intake from drinking water and rice in 45 households (75 individuals) in the An Giang province, Southern Vietnam. The daily i-As intake ranged from 28-102 µg d(-1), equivalent to the daily dose of 0.6-1.9 µg d(-1) kg((body wt))(-1). Increased As concentrations were observed in human hair in the study location. Approximately 67% (n = 44), 42% (n = 28), and 15% (n = 10) of the hair samples had As levels exceeding 1, 3, and 10 µg g(-1), respectively. The total As concentrations in female and male hair correlated well with the total daily i-As intake. Measurement of As concentrations in the hair of people who were consuming or had previously consumed As from contaminated sources may help predict the onset of negative health effects. We suggested an application of the Bayes's theorem to calculate the probability that an individual in a population will acquire a negative health effect, given that the concentration of arsenic in the subject's hair has been determined.