An atypical initial presentation of AIDS as cryptococcal lymphadenitis

Area of Science:

• Infectious Diseases
• Mycology
• Immunology

Background:

• Lymphadenopathy presents a diagnostic challenge, particularly in immunocompromised individuals.
• Antitubercular therapy (ATT) is often empirically initiated for suspected tuberculosis, despite potential for toxicity.

Observation:

• A patient presented with prolonged fever, dysphagia, cough, and weight loss, exhibiting pallor and abdominal lymphadenopathy on ultrasound.
• Initial sputum analysis for acid-fast bacilli was negative, yet ATT was administered without clinical response.

Findings:

• Fine-needle aspiration cytology revealed cryptococcal lymphadenitis as the definitive diagnosis.
• Treatment with amphotericin B followed by fluconazole led to significant clinical improvement and supported by ultrasonography.

Implications:

• Cryptococcus should be considered in the differential diagnosis of lymphadenopathy in acquired immunodeficiency syndrome (AIDS) patients.
• Misdiagnosis and empirical ATT can lead to treatment delays and potential hepatic/renal toxicity.
• Accurate etiological diagnosis is essential for appropriate antifungal management and improved patient outcomes.