Disseminated Disease Research Articles

The evaluation of minimal disseminated disease in the bone marrow of children with Burkitt lymphoma using next generation sequencing

The effectiveness of treatment for children with B-cell non-Hodgkin lymphomas (B-NHL) has reached 85–90% after the introduction of modern risk-adapted treatment regimens that involve risk group stratification based on tumor stage. Bone marrow involvement is traditionally evaluated using quantitative morphological analysis of tumor cells which has, however, a lower sensitivity compared to molecular genetic methods. In our study, we used next generation sequencing (NGS) to identify tumor-specific V-(D)/J-rearrangements of immunoglobulin genes which can be used as a marker for the evaluation of minimal disseminated disease (MDD) in children with B-NHL. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. Here we demonstrated that NGS allows detection of bone marrow involvement at a sensitivity of 10–6 in patients with Burkitt lymphoma, in whom standard morphological analysis failed to reveal the presence of tumor cells. The detection of molecular MDD can improve tumor staging and risk stratification in children with B-cell non-Hodgkin lymphomas.

Sodium thiosulfate as cisplatin otoprotectant in children: The challenge of when to use it.

Sodium thiosulfate as cisplatin otoprotectant in children: The challenge of when to use it.

Natal colony influences age-specific movement patterns of the Yellow-legged gull (Larus michahellis)

BackgroundAs for other life history traits, variation occurs in movement patterns with important impacts on population demography and community interactions. Individuals can show variation in the extent of seasonal movement (or migration) or can change migratory routes among years. Internal factors, such as age or body condition, may strongly influence changes in movement patterns. Indeed, young individuals often tend to move across larger spatial scales compared to adults, but relatively few studies have investigated the proximate and ultimate factors driving such variation. This is particularly the case for seabirds in which the sub-adult period is long and difficult to follow. Here, we examine migration variation and the factors that affect it in a common Mediterranean seabird, the Yellow-legged gull (Larus michahellis).MethodsThe data include the encounter histories of 5158 birds marked as fledglings between 1999 and 2004 at 14 different colonies in southern France and resighted over 10 years. Using a multi-event mark-recapture modeling framework, we use these data to estimate the probability of movement and survival, taking into account recapture heterogeneity and age.ResultsIn accordance with previous studies, we find that young individuals have greater mobility than older individuals. However, the spatial extent of juvenile movements depends on natal colony location, with a strong difference in the proportion of sedentary individuals among colonies less than 50 km apart. Colony quality or local population dynamics may explain these differences. Indeed, young birds from colonies with strong juvenile survival probabilities (~ 0.75) appear to be more sedentary than those from colonies with low survival probabilities (~ 0.36).ConclusionsThis study shows the importance of studying individuals of different ages and from different colonies when trying to understand seabird movement strategies. Local breeding success and the availability of food resources may explain part of the among colony differences we observe and require explicit testing. We discuss our results with respect to the feedback loop that may occur between breeding success and mobility, and its potential implications for population demography and the dissemination of avian disease at different spatial scales.

Pulmonary Histoplasmosis: A Clinical Update.

Histoplasma capsulatum, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. The most common clinical presentations include pulmonary histoplasmosis, which can resemble community-acquired pneumonia, tuberculosis, sarcoidosis, or malignancy; however, certain patients can develop mediastinal involvement or progression to disseminated disease. Understanding the epidemiology, pathology, clinical presentation, and diagnostic testing performance is pivotal for a successful diagnosis. While most immunocompetent patients with mild acute or subacute pulmonary histoplasmosis should receive therapy, all immunocompromised patients and those with chronic pulmonary disease or progressive disseminated disease should also receive therapy. Liposomal amphotericin B is the agent of choice for severe or disseminated disease, and itraconazole is recommended in milder cases or as "step-down" therapy after initial improvement with amphotericin B. In this review, we discuss the current epidemiology, pathology, diagnosis, clinical presentations, and management of pulmonary histoplasmosis.

Institutional performance and validation of severity of illness score for children with acute hematogenous osteomyelitis.

A scoring system has recently been published that uses parameters within the first 4-5 days of hospitalization to determine the severity of illness (SOI) in children with acute hematogenous osteomyelitis (AHO). To our knowledge, no additional studies to date have examined the validity of the SOI score outside of the institution of origin. This study evaluates the performance of the SOI score in a retrospective cohort of cases at our institution. Patients admitted to our institution over the past 5 years with AHO who met inclusion and exclusion criteria were analyzed. Parameters including C reactive protein over the first 96 h of hospitalization, febrile days on antibiotics, ICU admission, and presence of disseminated disease were used to calculate the SOI score for each patient. Pearson and Spearman correlations were used when appropriate. SOI score comparison between groups was achieved with the Kruskal-Wallis and Wilcoxon two-sample tests. Seventy-four patients were analyzed. Significantly higher SOI scores were noted for patients with bacteremia, ICU admission, fever for two or more days on presentation, multiple surgeries, and any complication. Markers of disease severity that significantly correlated with SOI score were total length of stay, LOS, duration of antibiotic course, number of surgical procedures, and case mix index. The SOI score functioned well as higher scores were associated with sicker patients. The SOI score is helpful for determining which patients will require longer hospitalizations and more intense treatment in a setting other than the institution of origin.

Evaluation of Host Constitutive and Ex Vivo Coccidioidal Antigen-Stimulated Immune Response in Dogs with Naturally Acquired Coccidioidomycosis.

The early innate immune response to coccidioidomycosis has proven to be pivotal in directing the adaptive immune response and disease outcome in mice and humans but is unexplored in dogs. The objectives of this study were to evaluate the innate immune profile of dogs with coccidioidomycosis and determine if differences exist based on the extent of infection (i.e., pulmonary or disseminated). A total of 28 dogs with coccidioidomycosis (pulmonary, n = 16; disseminated, n = 12) and 10 seronegative healthy controls were enrolled. Immunologic testing was performed immediately, without ex vivo incubation (i.e., constitutive), and after coccidioidal antigen stimulation of whole blood cultures. Whole blood cultures were incubated with a phosphate-buffered solution (PBS) (negative control) or a coccidioidal antigen (rCTS1 (105-310); 10 µg/mL) for 24 h. A validated canine-specific multiplex bead-based assay was used to measure 12 cytokines in plasma and cell culture supernatant. Serum C-reactive protein (CRP) was measured with an ELISA assay. Leukocyte expression of toll-like receptors (TLRs)2 and TLR4 was measured using flow cytometry. Dogs with coccidioidomycosis had higher constitutive plasma keratinocyte chemotactic (KC)-like concentrations (p = 0.02) and serum CRP concentrations compared to controls (p < 0.001). Moreover, dogs with pulmonary coccidioidomycosis had higher serum CRP concentrations than those with dissemination (p = 0.001). Peripheral blood leukocytes from dogs with coccidioidomycosis produced higher concentrations of tumor necrosis factor (TNF)-α (p = 0.0003), interleukin (IL)-6 (p = 0.04), interferon (IFN)-γ (p = 0.03), monocyte chemoattractant protein (MCP)-1 (p = 0.02), IL-10 (p = 0.02), and lower IL-8 (p = 0.003) in supernatants following coccidioidal antigen stimulation when compared to those from control dogs. There was no detectable difference between dogs with pulmonary and disseminated disease. No differences in constitutive or stimulated leukocyte TLR2 and TLR4 expression were found. These results provide information about the constitutive and coccidioidal antigen-specific stimulated immune profile in dogs with naturally acquired coccidioidomycosis.

Asynchronous thyroid metastases of malignant melanoma: report of a rarity

Thyroid metastasization is a very rare phenomenon with a challenging diagnosis. The incidence is 0.36% in all thyroid malignancies and it is reported it would be up to 2% after surgical specimens’ diagnosis. Thyroid metastasization of a malignant melanoma stands with an incidence of 2% in all thyroid secondarism. We report a 41-years old female with cutaneous malignant melanoma resected four years before the start of compressive symptoms secondary to multinodular goiter. Fine-needle-aspiration showed malignant cells of uncertain origin. A total thyroidectomy was performed. Histopathological examination showed multinodular metastases of malignant melanoma. Thyroid metastasis typically presents as a unifocal thyroid mass or nodule and may occur in the absence of a primary tumor diagnosis, thus leading to a misdiagnosis of thyroid primary tumor. Immunostaining and molecular testing are useful in case of doubt. Although metastases generally indicate disseminated disease, some patients may benefit from aggressive thyroid resection surgery when compared to conservative approaches. Newly-diagnosed thyroid mass in any patient with history of malignancy should raise suspicion for metastasizing. Although the overall prognosis of thyroid metastasis is poor, surgery could be an option in some cases with survival improvement or a palliative role.

Brain abscess nocardiosis: case report

Nocardiosis is an infection caused by Nocardia species, that are filamentous aerobic Gram-positive bacilli that belong to Actinomycetaceae family, it can cause a localized or a disseminated infection. Pulmonary disease is the most common presentation of nocardiosis in immunosuppressed patients and approximately one-third have a disseminated disease, that happens when lesions are found at two or more locations in the body. Nocardial brain abscesses are a rare central nervous system infection but has been highlighted as a differential diagnosis of brain tumors, due to the increase of the infection in deficient cell-mediated immunity patients. Even though nocardiosis represents only 2% of brain abscesses, it is an illness associated with significant mortality, present on 75% to 90% of cases. We present a case of central nervous system nocardiosis in a 59-year-old patient with a previous history of diabetes mellitus and alcoholic liver disease. The patient sought the emergency department with temporal occipital headache and mental confusion for 3 days. Imaging tests were performed that showed an oval lesion in the temporoparietooccipital region. Nocardiosis in the central nervous system was hypothesized and treatment was initiated. Despite medical support, the patient died. The lesion material was collected in which nocardiosis was diagnosed when analyzed histochemically.

Refractory Pneumonia in a 12-year-old Girl with Hemoglobin SS Disease

Refractory Pneumonia in a 12-year-old Girl with Hemoglobin SS Disease

Flexor Tenosynovitis Caused by Neisseria gonorrhea Infection: Case Series, Literature Review, and Treatment Recommendations.

Neisseria gonorrhoeae is the most common sexually transmitted disease in the world and is known to cause disseminated disease, most commonly tenosynovitis. Classically, gonorrhea-associated tenosynovitis presents with concomitant dermatitis and arthralgias, though this is not always the case. N. gonorrhoeae -related tenosynovitis has become more commonly seen by hand surgeons. To aid in management, we present three cases of gonorrhea-induced tenosynovitis spanning a range of presentations with variable treatments to demonstrate the variety of patients with this disease. Only one of our patients had a positive gonococcal screening test and no patient had purulent urethritis, the most common gonorrhea-related symptom. A separate patient had the classic triad of tenosynovitis, dermatitis, and arthralgias. Two patients underwent operative irrigation and debridement, and one was managed with anti-gonococcal antibiotics alone. Though gonorrhea is a rare cause of flexor tenosynovitis, it must always be on the differential for hand surgeons when they encounter this diagnosis. Taking an appropriate sexual history and performing routine screening tests can assist in the diagnosis, the prescription of appropriate antibiotics, and potentially avoiding an unnecessary operation.

Mobile phones as fomites for pathogenic microbes: A cross-sectional survey of perceptions and sanitization habits of health care workers in Dubai, United Arab Emirates.

In 2022, smartphone use continues to expand with the number of smartphone subscriptions surpassing 6 billion and forecasted to grow to 7.5 billion by 2026. The necessity of these 'high touch' devices as essential tools in professional healthcare settings carries great risks of cross-contamination between mobile phones and hands. Current research emphasises mobile phones as fomites enhancing the risk of nosocomial disease dissemination as phone sanitisation is often overlooked. To assess and report via a large-scale E-survey the handling practices and the use of phones by healthcare workers. A total of 377 healthcare workers (HCWs) participated in this study to fill in an E-survey online consisting of 14 questions (including categorical, ordinal, and numerical data). Analysis of categorical data used non-parametric techniques such as Pearson's chi-squared test. During an 8-h shift, 92.8% (n/N=350/377) use their phone at work with 84.6% (n/N=319/377) considering mobile phones as an essential tool for their job. Almost all HCWs who participated in this survey believe their mobile phones could potentially harbour microorganisms (97.1%; n/N=366/377). Fifty-seven respondents (15.1%) indicated that they use their phones while wearing gloves and 10.3% (n/N=39/377) have never cleaned their phones. The majority of respondents (89.3%; n/N=337/377) agreed that contaminated mobile phones could contribute to dissemination of SARS-CoV-2. Mobile phone use is now almost universal and indispensable in healthcare. Medical staff believe mobile phones can act as fomites with a potential risk for dissemination of microbes including SARS-COV-2. There is an urgent call for the incorporation of mobile phone sanitisation in infection prevention protocol. Studies on the use of ultraviolet-C based phone sanitation devices in health care settings are needed.

Development of a Heat-Killed fbp1 Mutant Strain as a Therapeutic Agent To Treat Invasive Cryptococcus Infection.

In previous studies, we determined that the F-box protein Fbp1, a subunit of the SCF(Fbp1) E3 ligase in Cryptococcus neoformans, is essential for fungal pathogenesis. Heat-killed fbp1Δ cells (HK-fbp1) can confer vaccine-induced immunity against lethal challenge with clinically important invasive fungal pathogens, e.g., C. neoformans, C. gattii, and Aspergillus fumigatus. In this study, we found that either CD4+ T cells or CD8+ T cells were sufficient to confer protection against lethal challenge by C. neoformans in HK-fbp1-induced immunity. Given the potent effect of HK-fbp1 as a preventative vaccine, we further tested the potential efficacy of administering HK-fbp1 cells as a therapeutic agent for treating animals after infection. Remarkably, administration of HK-fbp1 provided robust host protection against preexisting C. neoformans infection. The mice infected with wild-type H99 cells and then treated with HK-fbp1 showed significant reduction of fungal burden in the infected lung and no dissemination of fungal cells to the brain and spleen. We find that early treatment is critical for the effective use of HK-fbp1 as a therapeutic agent. Immune analysis revealed that early treatment with HK-fbp1 cells elicited Th1-biased protective immune responses that help block fungal dissemination and promote better host protection. Our data thus suggest that HK-fbp1 is both an effective prophylactic vaccine candidate against C. neoformans infection in both immunocompetent and immunocompromised populations and a potential novel therapeutic strategy to treat early-stage cryptococcosis. IMPORTANCE Invasive fungal infections, e.g., cryptococcosis, are often life threatening and difficult to treat with very limited therapeutic options. There is no vaccine available in clinical use to prevent or treat fungal infections. Our previous studies demonstrated that heat-killed fbp1Δ cells (HK-fbp1) in Cryptococcus neoformans can be harnessed to confer protection against a challenge by the virulent parental strain, even in immunocompromised animals, such as ones lacking CD4+ T cells. In this study, we further determined that T cells are required for vaccine-induced protection against homologous challenge and that either CD4+ or CD8+ cells are sufficient. This finding is particularly important for the potential utility of this vaccine candidate in the context of HIV/AIDS-induced immune deficiency, the main risk factor for cryptococcosis in humans. Furthermore, in addition to the utility of HK-fbp1 as a prophylactic vaccine, we found that HK-fbp1 administration can inhibit disease dissemination when animals are treated at an early stage during Cryptococcus infection. Our findings could significantly expand the utility of HK-fbp1 not only as a prophylactic vaccine but also as a novel therapy against cryptococcosis. In all, our studies showed that the HK-fbp1 strain can be used both preventively and therapeutically to elicit robust host protection against cryptococcosis.

Dynamic behavior of infectious diseases influenced by TV and social media advertisement

TV and social media advertisements play an significant role in curbing the spread of infectious diseases as most of the populations are depend on what media transmits to them. In this paper, taking into account white noises, we propose a mathematical model to study the influences of TV and media advertisements on the dissemination of diseases. Construction of Lyapunov function is the top priority of this paper, which makes us draw a series of meaningful conclusions. We first discuss the local stability of the endemic equilibrium by Lyapunov function method which avoids the tedious calculation process when studying the local stability of the positive solution of the high-dimensional model. Then we obtain that the stochastic system has a unique global positive solution with any initial value. Next, the persistence of the diseases is proved and it also means that this model has an ergodic stationary distribution. Moreover, constructing a Lyapunov function can be used to derive the sufficient conditions for extinction. Finally, the numerical simulations illustrate our above theoretical results and several parameters that have a significant impact on the model are pointed out.

Insights into the medical management of gastrointestinal stromal tumours: lessons learnt from a dedicated gastrointestinal stromal tumour clinic in North India.

The advent of molecular driver alterations has brought in a revolutionary transformation in the treatment landscape of gastrointestinal stromal tumour (GIST). However, there is a paucity of data regarding mutational testing prevalence and associated outcomes from India. It was a retrospective study. We reviewed the case records of all patients diagnosed with GIST in a tertiary care centre from 2015 to 2021. The clinicopathological, mutational analysis and treatment plans were recorded. The study cohort was characterised by descriptive statistics. Our study included 120 patients with a median age of 53 years (range: 28-77), with a male preponderance of 2:1. The most common site of the primary was the stomach (50%), followed by the small intestine (37%), with 55.8% of the patients having disseminated disease at presentation with a predominance of liver metastasis (67%). The prevalence of mutational analysis among patients prior to referral was 4%. 60.8% of the patients at our clinic had mutational analysis performed, and unavailability of analysis in the rest was due to financial constraints (12.5%), exhaustion of tissue (7.5%), reluctance to repeat biopsy (4.1%) and low-risk patients. We report c-kit in the majority (52%), platelet-derived growth factor receptor (PDGFR) in 19.2% and wild type in 16.4% along with the rarer subtypes: succinate dehydrogenase (SDH)-deficient GIST in 10.9% and Neurotrophic tyrosine receptor kinase (NTRK) fusion in 1.3%. Four of the eight SDH-deficient GIST patients had germline mutations (50%). The knowledge of driver mutations led to a change of treatment in 39.7% (29/73), i.e. stoppage of tyrosine kinase inhibitor (TKI) in 3, switch of TKI in 23, increase in TKI dose in 2 and upfront surgery in 1. The most common change was the use of sunitinib and regorafenib in patients with SDH-deficient GIST. Our study is one of the largest comprehensive series describing the clinical and mutational profile of GIST from India. The mutation testing rates at primary care centres continue to be low. Despite the hurdles, a large percentage of our patients underwent molecular testing, aiding in therapeutic decision-making.

Assessing the impact of climate conditions on the distribution of mosquito species in Qatar.

Qatar is a peninsular country with predominantly hot and humid weather, with 88% of the total population being immigrants. As such, it leaves the country liable to the introduction and dissemination of vector-borne diseases, in part due to the presence of native arthropod vectors. Qatar's weather is expected to become warmer with the changing climatic conditions across the globe. Environmental factors such as humidity and temperature contribute to the breeding and distribution of different types of mosquito species in a given region. If proper and timely precautions are not taken, a high rate of particular mosquito species can result in the transmission of various vector-borne diseases. In this study, we analyzed the environmental impact on the probability of occurrence of different mosquito species collected from several different sites in Qatar. The Naive Bayes model was used to calculate the posterior probability for various mosquito species. Further, the resulting Naive Bayes predictions were used to define the favorable environmental circumstances for identified mosquito species. The findings of this study will help in the planning and implementation of an active surveillance system and preventive measures to curb the spread of mosquitoes in Qatar.

Abstract IA001: Metastasis initiating cells and ecosystems

Abstract Metastasis is initiated and sustained through therapy by cancer cells with stem-like properties, termed metastasis initiating cells (MICs). Recent work suggests that MICs are malignant cells that adopted a regenerative stem-cell phenotype with intrinsic programs to survive the physical, immune and metabolic stresses of the metastatic process, enter a slow-cycling state for dormancy, and establish supportive interactions with organ-specific ecosystems for eventual outgrowth and recurrence. Notably, relapse frequently develops from disseminated MICs that remain dormant in distant organs after the apparently successful treatment of a primary tumor. During dormancy, MICs fluctuate between immune evasive quiescent and cell cycle reentry states, which exposes them to elimination by the immune system. By combining novel immunocompetent mouse models of lung adenocarcinoma indolent metastasis, in vivo genetic screens, immune profiling, and pre-clinical anti-tumor drug testing, we identified specific pathways in reawakened MICs that drive immune-mediated clearance and can be therapeutically activated to hasten the elimination of residual disseminated disease. Moreover, analysis of brain metastasis with advanced imaging reveals that the interplay between MICs and their host ecosystem is influenced by the architecture of metastatic colonies. Thus, lung adenocarcinoma and triple-negative breast cancer metastases grow by spreading on the basement membrane of brain capillaries, forming perivascular tumor colonies that closely interact with microglia and astrocytes. In contrast, HER2+ breast cancer cells adopt a spheroidal growth pattern that is driven by tumor-derived extracellular matrix and restricts microglia and astrocyte infiltration. The use of single-cell analytics revealed distinct microglia activation states, MIC dependencies and vulnerabilities associated with these different growth patterns. This progress sheds light on the complex and dynamic interplay between MICs and their host ecosystems and point at therapeutically actionable targets to hasten the elimination of disseminated disease. Citation Format: Joan Massagué. Metastasis initiating cells and ecosystems [abstract]. In: Proceedings of the AACR Special Conference: Cancer Metastasis; 2022 Nov 14-17; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_2):Abstract nr IA001.

Gastric Polyp

Abstract Mucormycosis is usually an infection of immunocompromised patients. In the COVID-19 pandemic, its incidences increased due to immunocompromised states and injudicious use of steroids. It usually causes sinusitis and orbital involvement and may extend to the brain causing life-threatening condition. Involvement of gastrointestinal tract is rare. The stomach is the most commonly involved part followed by colon and ileum. It is mostly a part of disseminated disease. Here we are describing a case of dyspepsia that was diagnosed to have rare fungal infection without involving other usual sites.

‘Eradication was a dirty word’: Anti-gambiae campaign, between cooperation and rivalry (1938–1940)

ABSTRACT This article analyzes the efforts of the International Health Division of the Rockefeller Foundation (IHDRF) in its project initiative that resulted in the extermination of the African mosquito Anopheles gambiae from Brazil in 1940. This species, which originated in Dakar, Senegal, was identified in the Brazilian city of Natal in 1930, where insufficient local emergency sanitation actions enabled it to spread into the interior of the Brazilian northeast, causing an unprecedented malaria epidemic in the Americas in 1938, after years of silent spread. We will analyse the formation of Brazil’s Malaria Service of the Northeast (MSNE), discussing its political and scientific controversies and how the transition from the idea of extermination to the idea of eradication was consolidated in the political process of creating this successful sanitation campaign. In addition, we will discuss how the integration and transnational development of medical entomology at the time was a fundamental factor in the cooperation and challenges among scientists involved in this campaign. The international cooperation of scientists, albeit oriented towards the project of eradication of this mosquito, organised different research agendas and gained new insights into the global dissemination of mosquito-borne diseases.

Adenovirus disease after hematopoietic cell transplantation

Adenovirus disease can cause disseminated disease or lethal organ damage in patients undergoing hematopoietic cell transplantation (HCT). Renourinary infection is the most common in Japan. The 1-year cumulative incidences of adenovirus disease in children and adults were 0.15% and 0.49%, respectively, after autologous HCT, and 1.52% and 2.99%, respectively, after allogeneic HCT. The annual incidence remained above 100 cases. Viremia or disseminated disease after autologous and allogeneic HCT occurs in 6% and 19%, respectively, in patients with adenovirus disease. Age ≥50 years and lymphoma are associated with adenovirus disease after autologous HCT. Patient age ≥50 years, male patients, adult T-cell leukemia/lymphoma, lymphoma, HCT-specific comorbidity index ≥3, HLA-mismatched or haploidentical donors, cord blood, in vivo T-cell depletion, grades II-IV acute graft-versus-host disease (GVHD), and extensive chronic GVHD are associated with adenovirus disease after allogeneic HCT. No regulatory authority has approved an antiviral agent for treating adenovirus disease after HCT. More than half of the patients received only supportive care in Japan. The increased risk of mortality following developing adenovirus disease, even with a single-site infection, after both autologous and allogeneic HCT suggests an urgent unmet need for the development of safe and effective drugs.

Criptococose cutânea: doença sistêmica ou localizada?

Cutaneous cryptococcosis is a fungal infection that can manifest as localized or disseminated disease in both immunocompetent and immunocompromised patients. The present report describes a case of an 81-year-old man from the rural area of Bahia, with the cutaneous form of the disease. Initially the patient was considered to have primary cryptococcosis and was treated with fluconazole. However, in order to rule out disseminated disease, the patient underwent chest tomography, which showed pulmonary nodules that, associated with positive antigenemia, justified the change to liposomal amphotericin B. There was a satisfactory clinical response with no evident complications related to the treatment, but a late metastatic prostate cancer diagnosis allowed to question the supposed fungal infection spread. The differentiation between localized and disseminated cryptococcosis is difficult, but it is fundamental for the proper direction of treatment.