Multifocal cryptococcal disease in an HIV-infected patient: from diagnostic pursuit to management peculiarities

Area of Science:

• Mycology
• Infectious Diseases
• Immunocompromised Host

Background:

• Cryptococcosis is a severe fungal infection primarily affecting immunocompromised individuals, commonly causing meningoencephalitis and pneumonia.
• Lymph node involvement in cryptococcosis is infrequent and often clinically subtle.
• This report details a patient with acquired immunodeficiency syndrome (AIDS) who experienced multifocal cryptococcal disease.

Observation:

• The patient, recently diagnosed with AIDS and treated for cryptococcal meningitis, developed cervical and mediastinal lymphadenitis and constitutional symptoms.
• Despite ongoing antifungal therapy, the new symptoms mimicked other conditions like tuberculosis or malignancy, complicating diagnosis.
• Initial cryptococcal meningitis had resolved, making the relapse or new manifestation challenging to identify.

Findings:

• Multifocal cryptococcal disease manifested as lymphadenitis in cervical and mediastinal nodes.
• Diagnosis was confirmed via fine-needle aspiration cytology identifying *Cryptococcus*.
• The clinical presentation posed a diagnostic challenge due to resolved meningitis and overlapping symptoms with other diseases.

Implications:

• This case underscores the importance of considering cryptococcosis in immunocompromised patients with atypical presentations, even after initial treatment success.
• Distinguishing between cryptococcal disease relapse and cryptococcal immune reconstitution inflammatory syndrome (cIRIS) is crucial for appropriate management.
• Extended antifungal therapy based on clinical response was implemented, highlighting the complex management strategies required for such cases.