A case of disseminated Cryptococcus neoformans in a non HIV patient

Abstract

Background: Cryptococcus neoformans predominantly causes significant infections in immunocompromised individuals, of which 80–90% occur in people infected with human immunodeficiency virus (HIV). The clinical manifestations can vary from asymptomatic colonization of the respiratory airways to dissemination of infection into any part of the human body. Disseminated cryptococcal infection especially noncutaneous cryptococcal abscess in immunocompetent host is uncommon. We report a case of disseminated Cryptococcus neoformans with soft tissue and pulmonary involvement in an otherwise healthy immunocompetent patient diagnosed by culture of the abscess. Case Description: Mr S, 72 y old Malay man, no known medical illness, a farmer at palm oil plantation in Benut, Johor, presented with progressive anterior chest wall swelling for 1 week duration associated with fever. CECT thorax showed left upper lobe and right chest wall abscess complicated with septic arthritis and osteomyelitis. The swelling was incised and pus was drained. Histopathological examination showed numerous encapsulated yeast like organism with thick capsule. Culture from tissue and pus of this patient grew Cryptococcus neoformans var grubii. Patient was treated as disseminated Cryptococcus neoformans and responding well to Amphotericin B. Discussion: Cryptococcal infections are common in immunosuppressed and relatively rare among immunocompetent population. In this case, the culture of the pus grew Cryptococcus neoformans serotype A (var. grubii) identified by Malditof. This variant of Cryptococcus is most commonly isolated from AIDS patient. The pathogenesis of cryptococcosis is rely on status of host defences, virulence strain and size of the inoculums. The mode of transmission in this case as he is a farmer, most likely from inhalation and direct of inoculation of the pathogen. Conclusion: Absence of immunosuppression should not be a reason to exclude cryptococcosis from the differential diagnosis when patient presents with an abscess.