A Case of Generalized Cryptococcal Infection in an HIV-Infected Patient with Coinfections of Cytomegalovirus and Tuberculosis

Abstract

This case report presents the observation of a patient with HIV infection diagnosed with a combination of several opportunistic infections, including cryptococcosis, cytomegalovirus infection and tuberculosis. The patient underwent treatment at the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine and the Institute of Epidemiology and Infectious Diseases named after L.V. Gromashevsky NAMS of Ukraine.HIV infection was detected at the Institute of Phthisiology and Pulmonology during an examination for exudative pleuritis. Initial evaluation raised suspicion of tuberculous exudative pleuritis. Mycobacterium tuberculosis was not detected in the biopsy material using the Xpert MTB/RIF method. Morphological analysis indicated a rare variant of cryptococcal infection involving intrathoracic lymph nodes and pleura. Additional testing revealed a positive cryptococcal antigen. Cryptococci were also identified in the cerebrospinal fluid. Cytomegalovirus chorioretinitis was diagnosed. The patient was treated according to the opportunistic infection management protocol. Antiretroviral therapy (TDF, FTC, DTG — tenofovir, emtricitabine, dolutegravir) was initiated after six weeks. The patient received prophylaxis for Pneum­cystis pneumonia with cotrimoxazole and for tuberculosis with isoniazid. One month after starting antiretroviral therapy, the patient developed a febrile illness. Further examination revealed infiltrative pulmonary tuberculosis. Repeat bacteriological testing detected rifampicin-susceptible Mycobacterium tuberculosis. The patient received standard tuberculosis treatment (2HRZE/4HR) and achieved a cure.This case highlights the diagnosis and treatment of a patient with acquired immunodeficiency syndrome and multiple secondary infections. Despite advanced immunodeficiency, timely and adequate medical interventions resulted in high treatment efficacy, contributing to increased life expectancy and improved quality of life in individuals living with HIV.