An Unusual Presentation of Disseminated Cryptococcosis in a Middle Aged Female

Avijit Das Dipankar Pal

doi:10.4172/2329-9088.1000183

Abstract

Cryptococcosis is a common opportunistic pathogen in the setting of advanced human immunodeficiency virus (HIV) infection especially with CD4 count less than 50 cells/micro liter and in other immunodeficient conditions such as hematologic malignancies, transplant recipients or in persons on prolonged glucocorticoid and/or immunosuppressant therapy. Disseminated cryptococcosis is uncommon in immunocompetent person. We detected such a case at our institute presented initially with pulmonary mass lesion and later evolving into chronic non-healing skin ulcer and asymptomatic brain involvement without having any evidence of overt immunosuppression. However the patient developed gall-bladder carcinoma about one and half years after her chest complaints. She underwent surgical resection but neither received radiotherapy nor chemotherapy post-surgery. She was treated successfully with anti-fungal combination therapy as per Infectious Diseases Society of America (IDSA) guideline.

Highlights

Cryptococcosis is caused by an encapsulated fungus called Cryptococcus neoformans
It has a worldwide distribution and mainly acquired from environment by inhalation of aerosolised infectious particles. It is an opportunistic yeast found frequently in soil contaminated with pigeon and other bird droppings. It can affect any tissue or organ, but majority of cases that come to clinical attention involves the central nervous system (CNS) and/or lungs [1]
Contrast enhanced CT (CECT) scan thorax was done after one month (Figure 1) along with a guided FNAC from left lung lesion which revealed granulomatous pathology without evidence of any acid fast bacilli (AFB)

Summary

Introduction

Cryptococcosis is caused by an encapsulated fungus called Cryptococcus neoformans. It has a worldwide distribution and mainly acquired from environment by inhalation of aerosolised infectious particles. Contrast enhanced CT (CECT) scan thorax was done after one month (Figure 1) along with a guided FNAC from left lung lesion which revealed granulomatous pathology without evidence of any acid fast bacilli (AFB). She was put on anti-tubercular drugs (ATD) empirically (rifampicin, INH, pyrazinamide and ethambutol). Keeping in mind the atypical brain imaging appearance of our case, a granulomatous infection like tuberculoma would have been more appropriate possibility in Indian scenario Considering her clinical background, we kept CNS cryptococcosis as primary possibility (patient did not consent to brain biopsy) and subsequently, positive response to treatment validated our diagnosis. ↓Five months later Clinically improved, MRI brain and X-Ray chest revealed regression of the lesions

Discussion

Conclusion