Primary cryptococcal prostatitis in an apparently uncompromised host

Systemic spread from a primary focus of cryptococcal infection commonly involves the central nervous system, manifested as meningitis or meningoencephalitis. Untreated meningitis and meningoencephalitis are invariably fatal, following a subacute or chronic course of cyclic remission and relapse, followed by progressive deterioration over weeks to months. Occasional patients with fulminating meningoencephalitis die within a few days. Incorrect diagnosis may be the most common cause of fatality in this disease. Thorough histopathologic examination and blood and body fluid studies should minimize misdiagnosis.

We studied the case of an initially misdiagnosed 64-year-old apparently immunologically competent man with primary cryptococcal prostatitis that subsequently disseminated to the central nervous system and the left eye. All immunologic findings including workup for AIDS viruses were normal. Laboratory studies confirmed cryptococcal infection.

After initial misdiagnosis, our patient received improper treatment for 10 months. He developed meningitis and severe left endophthalmitis with optic nerve and retinal involvement. Toxic medications led to kidney insufficiency with about 66% loss of function. Following therapy, reevaluation of his immune system showed marked abnormality in cell-mediated immunity.

Cryptococcosis is easily misdiagnosed in uncompromised hosts, both clinically and pathologically, because of misconception that the disease affects only immunocompromised individuals and that primary cryptococcal prostatitis is virtually unheard-of in "normal" males.