A 55-year-old man presented with a chronic cheek ulcer which had appeared 2 months earlier. Cephalexin, followed by amoxicillin/clavulanate and then with moxifloxacin did not resolve the issue. The patient has a medical history of hypertension.
Physical examination. The following were noted: Vital signs: temperature, 99.4°F; pulse, 80 beats/min; respiratory rate, 16 breaths/min; blood pressure, 130/80 mm Hg General: non-ill-appearing HEENT: nickel-sized ulcer on the cheek, slightly raised edges, nonpainful Lungs: normal Heart: normal Abdomen: normal Extremities/skin: normal Diagnostic Evaluation The following values were obtained: WBC count: 9200 cells/µL Hemoglobin level: 11.2 g/dL Differential: 8% lymphocytes; 2% monocytes; 90% polymorphonucleocytes Culture: Cryptococcus gattii Biopsy: yeast forms and granuloma Serum cryptococcal antigen: negative HIV: negative CD4 count: 186…
