Profound muscle weakness as the presenting feature of disseminated cryptococcal infection

A patient with chronic lymphocytic leukemia who was treated with immunosuppressive therapy for a prolonged period presented with profound muscle weakness secondary to disseminated cryptococcosis. The infection developed despite 3 months of continuous ketoconazole therapy and was not responsive to amphotericin B or flucytosine. At autopsy, Cryptococcus neoformans was present in all sampled skeletal muscles, myocardium, and muscularis propria of the gastrointestinal tract but was not identified in either the central nervous system or the lungs. A review of the English-language literature failed to identify a similar case with such profound myotropism due to Cryptococcus. This case demonstrates that cryptococcosis should be considered in the differential diagnosis of an immunocompromised host presenting with muscle weakness.