Disseminated cryptococcosis, an unusual cause of gross proteinuria in an HIV-infected patient.

Abstract

Sir, A 52-year-old HIV-positive, ARV-naive African man was admitted with cryptococcal meningitis. Pertinent laboratory investigations included a serum creatinine of 170 mcmol/l, a urinary albumin creatinine ratio of 50 mg/mmol and urinary sodium of 268 mmol/24 h. His CD4 count was 15 cells/ml. Both hepatitis B and C serology were negative. Renal ultrasound showed normal-sized kidneys with increased renal parenchymal echogenicity suggestive of HIV-associated nephropathy. A renal biopsy, which yielded eighteen glomeruli, showed cryptococcal yeasts in some of the glomerular capillaries, tubules and within the interstitium with minimal inflammatory response. There was no evidence of collapsing glomerulopathy. The final diagnosis was cryptococcal meningitis with fungaemia and nephritis. Fig. 1 Glomerulus showing yeast forms of cryptococcocus in one of the capillary loops. Note the relatively normal background (mucicarmine ×20). Fig. 2 Mucicarmine stain highlighting the capsule of the budding yeast forms tubular lumina (×40). The patient was initially started on antifungal therapy and both his clinical state and serum creatinine improved. He was planned for highly active antiretroviral therapy as an outpatient, however, was lost to follow up on discharge.