Abstract: A 78-year-old male was admitted to our hospital because of erythema,edema and ulcer on the scalp for about 10 days.Ten days prior to the presentation,small erythematous papules with mild pruritus occurred on the scalp.The lesion rapidly developed ulcer covered with necrotic crust in the center with a well-circumscribed border and an erythmatous halo.Histopathology,bacterial culture and fungal examination were carried out with specimens collected from the border of the ulcer.A mouse model was established to study the pathogenicity of the isolate.Histopathology showed hyperkeratosis and parakeratosis of epidermis,as well as proliferation of fibrous tissue and infiltration of mixed inflammatory cells in dermis. PAS stain demonstrated the presence of numerous spores.Bacterial culture was negative.Fungal culture yielded single yeast colonies.The urease and caffeic acid tests of the isolate were positive.The fungi were collected from the culture,diluted,and inoculated into four mice.Four days later,one mouse died;seven days later,the remaining three mice were killed,and ink staining of brain tissue from these mice found a mass of spores coated by thick capsules.The isolated strain was identified as Cryptococcus neoformans by the above findings.One month after the treatment with oral itraconazole 0.2 g twice a day,the ulcer improved,and fungal culture of the scales on the surface of the lesion was negative.Five months later,the ulcer completely healed and hair regrowth was observed.

Key words: Cryptococcosis, Ulcer, Itraconazole