LAUSR

DEAR EDITOR, A 52-year-old man developed a painless ulcer a few days after pigeon droppings fell on his intact forehead. He reported a history of multiple unprotected sexual encounters and was diagnosed, by skin biopsy (haematoxylin and eosin and periodic acid–Schiff staining), with cryptococcosis and HIV infection. Six weeks later the patient presented with fever and difficulty breathing; pulmonary computed tomography scan and cerebrospinal fluid culture confirmed systemic dissemination. The patient’s cutaneous and general condition substantially improved after antiretroviral and antifungal treatment. The unusual story of pigeon droppings should prompt biopsy; the patient’s personal history and cryptococcosis indicated potential immunodeficiency and the need for HIV testing. Acknowledgments