Disseminated Cryptococcal Disease in Non-HIV, Nontransplant Patient

Area of Science:

• Infectious Diseases
• Hematology
• Oncology

Background:

• Disseminated cryptococcal infection (DCI) is a severe condition with high mortality.
• It typically affects individuals with advanced HIV or those who have undergone solid organ or hematopoietic stem cell transplantation.
• Patients with hematologic malignancies and those receiving chemotherapy are also at risk.

Purpose of the Study:

• To report a case of disseminated cryptococcal disease in an immunocompromised patient with chronic lymphocytic leukemia (CLL).
• To describe the clinical presentation, diagnostic process, and management of DCI in this specific patient population.

Main Methods:

• A case report of a 72-year-old male with CLL undergoing fludarabine/cyclophosphamide/rituximab (FCR) chemotherapy.
• Diagnosis was confirmed by fungemia in blood cultures and evidence of DCI involving the brain, lungs, and eyes.
• Treatment involved induction therapy with liposomal amphotericin B, flucytosine, and fluconazole, followed by consolidation and maintenance therapy.

Main Results:

• The patient presented with constitutional symptoms and headache after FCR chemotherapy.
• Disseminated cryptococcal disease was confirmed with positive blood cultures and multi-organ involvement.
• Successful treatment was achieved with a combination antifungal regimen.

Conclusions:

• Disseminated cryptococcal infection is a significant risk in patients with chronic lymphocytic leukemia undergoing chemotherapy.
• Early diagnosis and appropriate combination antifungal therapy are crucial for managing DCI in this population.
• This case underscores the importance of considering DCI in immunocompromised patients presenting with relevant symptoms.