Paradoxical respiratory failure due to cryptococcal pneumonia after amphotericin B treatment for HIV-associated

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James E Scriven1,2, Francois Cj Botha3, Charlotte Schutz1,4

  • 1Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa.

Medical Mycology Case Reports
|January 31, 2018
PubMed

Insights

A patient with HIV-1 infection and cryptococcal meningitis experienced rapid respiratory failure after starting amphotericin B. Post-mortem revealed severe necrotizing cryptococcal pneumonia, highlighting its underrecognition in HIV patients with respiratory symptoms.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • HIV Medicine

Background:

  • Cryptococcal meningitis is a serious opportunistic infection in individuals with Human Immunodeficiency Virus (HIV-1) infection, particularly those with low CD4 counts.
  • Respiratory symptoms in HIV-1 positive patients often prompt consideration of Pneumocystis pneumonia (PCP).

Purpose of the Study:

  • To highlight the underrecognized entity of severe necrotizing cryptococcal pneumonia.
  • To emphasize the importance of considering cryptococcal pneumonia in the differential diagnosis of respiratory failure in HIV-1 infected individuals.

Main Methods:

  • Case presentation of a 27-year-old female with HIV-1 infection.
  • Clinical course including initiation of amphotericin B deoxycholate therapy for cryptococcal meningitis.
  • Radiological findings (Chest X-ray) and post-mortem examination results.

Main Results:

  • The patient developed rapidly worsening respiratory failure shortly after initiating antifungal therapy.
  • Chest X-ray suggested Pneumocystis pneumonia.
  • Post-mortem examination confirmed severe necrotizing cryptococcal pneumonia.

Conclusions:

  • Severe necrotizing cryptococcal pneumonia is an underrecognized cause of respiratory failure in HIV-1 infected patients.
  • Cryptococcal pneumonia should be strongly considered in the differential diagnosis for HIV-1 patients with low CD4 counts presenting with respiratory symptoms.
  • Prompt recognition and appropriate management are crucial for improving outcomes in these patients.
Keywords:
Amphotericin B deoxycholateCryptococcal pneumoniaCryptococcus neoformansParadoxical deteriorationRespiratory failure

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