Open AccessMultifocal cryptococcal disease in an HIV-infected patient: from diagnostic pursuit to management peculiarities
Author(s) -
Isabel Eira,
Filipa Pinho,
Cindy Tribuna,
Ángela Cristina
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-232909
Subject(s) - medicine , cryptococcus , cryptococcosis , immune reconstitution inflammatory syndrome , tuberculosis , malignancy , cryptococcus neoformans , meningoencephalitis , disease , meningitis , lymph node , aids related opportunistic infections , rare disease , immunology , dermatology , pediatrics , pathology , human immunodeficiency virus (hiv) , viral disease , antiretroviral therapy , viral load , sida , genetics , microbiology and biotechnology , biology
Cryptococcosis is a life-threatening fungal infection that affects immunocompromised patients, causing predominantly meningoencephalitis and pneumonia. Lymph node involvement is rare and its identification may not be obvious. We report the case of a patient recently diagnosed with AIDS and previously treated for cryptococcal meningitis who developed multifocal cryptococcal disease despite antifungal treatment, expressed as cervical and mediastinal lymphadenitis and constitutional symptoms. The difficulty of the diagnosis was based on the fact that cryptococcal meningitis was resolved after treatment, and the new manifestations were more typical of other conditions such as tuberculosis and malignancy. Final diagnosis was established after fine-needle aspiration cytology of a lymph node with Cryptococcus identification. Such cases may be difficult to manage, and the possibility of clinical relapse versus cryptococcal immune reconstitution inflammatory syndrome is discussed. Induction therapy was restarted and maintained for a longer period, and the total duration was based on clinical response.