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Pediatric renal cryptococcosis: novel manifestations in the acquired immunodeficiency syndrome era

Pratistadevi K Ramdial1, Yetish Sing, Julian Deonarain

  • 1Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal & National Health Laboratory Service, Durban, KwaZulu Natal, South Africa. ramdial@ukzn.ac.za

International Journal of Surgical Pathology
|July 21, 2010
PubMed

Insights

Pediatric renal cryptococcosis (RC) is newly documented in children with AIDS. This study highlights the kidney as a potential site for cryptococcal immune reconstitution inflammatory syndrome (IRIS).

Area of Science:

  • Pediatric infectious diseases
  • Nephrology
  • Immunology

Background:

  • Pediatric renal cryptococcosis (RC) has not been previously documented.
  • Human immunodeficiency virus (HIV) infection in children can lead to various opportunistic infections and renal complications.

Observation:

  • Two pediatric patients with acquired immunodeficiency syndrome (AIDS) presented with proteinuria and were diagnosed with RC.
  • One patient developed cryptococcal immune reconstitution inflammatory syndrome (IRIS) with specific glomerular and interstitial inflammatory reactions to Cryptococcus neoformans.
  • The other patient showed typical HIV-associated nephropathy with Cryptococcus neoformans presence.

Findings:

  • This case series reports the first documented instances of pediatric RC.
  • The findings suggest the kidney can be a site for cryptococcal IRIS in children with AIDS.
  • Specific pathological findings included glomerular and interstitial inflammation and the presence of capsule-deficient fungal forms.

Implications:

  • Pediatric AIDS-associated renal disease classifications should be expanded to include RC and cryptococcal IRIS.
  • The kidney should be recognized as a potential sentinel organ for IRIS in pediatric patients with HIV.
  • Early recognition and management of RC and cryptococcal IRIS are crucial for improving outcomes in pediatric AIDS.

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