Cryptococcosis masquerading as a tuboovarian abscess

Area of Science:

• Medical Mycology
• Gynecologic Pathology
• Infectious Diseases

Background:

• Human immunodeficiency virus (HIV) infection can predispose individuals to opportunistic fungal infections.
• Pelvic masses in women can present with diverse etiologies, requiring thorough diagnostic evaluation.
• Tuboovarian abscesses are common gynecologic infections, typically treated with antibiotics.

Observation:

• A 25-year-old HIV-seropositive patient presented with symptoms suggestive of a tuboovarian abscess.
• Initial antibiotic therapy was ineffective, leading to surgical intervention.
• A large ovarian pseudocystic mass was surgically excised, revealing gelatinous material and viscid fluid.

Findings:

• Histopathological examination revealed a cryptococcoma, characterized by Cryptococcus neoformans yeast within a pseudocystic ovarian mass.
• The mass was lined by granulation tissue and contained extracellular yeast lakes.
• The macroscopic diagnosis of mucinous cystadenocarcinoma was refuted by microscopic findings.

Implications:

• This case represents the first reported instance of ovarian cryptococcosis in the English literature.
• Fungal infections, though rare in the female genital tract, should be considered in the differential diagnosis of refractory pelvic masses.
• Clinicians should maintain a high index of suspicion for opportunistic infections in immunocompromised patients presenting with pelvic pathology.