Cryptococcal pleural infection in a recurrent pleural effusion: a case report

Area of Science:

• Infectious Diseases
• Pulmonology
• Oncology

Background:

• Cryptococcal pleural infection is a rare clinical entity, with limited reported cases.
• The condition predominantly affects immunocompromised individuals, presenting diagnostic challenges.
• Pleural effusions in immunocompromised patients can be caused by various pathogens, including fungi.

Observation:

• A 38-year-old male presented with lymphocytic exudative pleural effusion and elevated adenosine deaminase (ADA) levels.
• Initial treatment for presumed pleural tuberculosis was unsuccessful, with disease progression.
• Thoracoscopic pleural biopsy revealed granulomatous pleuritis with Cryptococcus organisms.

Findings:

• Pleural fluid culture confirmed *Cryptococcus neoformans* infection.
• The patient was diagnosed with acute myeloid leukemia (AML) with significant blast cell presence.
• This case highlights opportunistic fungal infections presenting as exudative pleural effusions with elevated ADA.

Implications:

• Raised pleural fluid ADA levels and lymphocytic exudative effusions in immunocompromised patients warrant consideration of opportunistic fungal infections.
• Prompt identification and treatment of cryptococcal infections are vital in immunocompromised hosts, particularly those with hematologic malignancies.
• This case underscores the importance of a broad differential diagnosis in immunocompromised patients with pleural effusions.