A Fatal Case of Misdiagnosed Cryptococcal Epididymo-Orchitis and Leg Cellulitis in a HIV-Negative Patient

Abstract

Patients with disorders of T-cell mediated immunity are at high risk for cryptococcal infection. We present a 61-year-old male who was receiving corticosteroid therapy for vasculitis-associated necrotizing glomerulonephritis. The patient presented with fever, right orchiepididymitis and cellulitis of both legs. Despite surgical and combined antibiotic treatment, he developed septic shock and multi-organ dysfunction. Histological examination of skin lesion revealed acute panniculitis and numerous fungi spores, while blood cultures revealed <i>Cryptococcus neoformans.</i> Further stains on the testis specimen confirmed also the presence of Cryptococcus. The patient received amphotericin B and his clinical condition and laboratory findings were improved. However, he developed septic shock due to multi-drug resistant <i>Klebsiella pneumoniae</i> nosocomial pneumonia and he finally died. Cryptococcal infection should be added to the differential diagnosis of epididymo-orchitis and cellulitis in immunocompromised hosts. Early diagnosis and therapy are essential if the case-fatality rates associated with disseminated infection are to be improved. J Med Cases. 2013;4(3):179-181 doi: https://doi.org/10.4021/jmc1053e