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A Trespasser in Lymph Node: A Case Report
Priyankha Ramamoorthy1, Barathi Gunabooshanam1, Subalakshmi Balasubramanian1
1Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Abstract:
Cryptococcal meningitis is a prevalent, opportunistic fungal disease seen in human immunodeficiency virus (HIV)-infected individuals. A lymph node is an unusual presentation site for Cryptococcus and can mimic tuberculosis. Disseminated cryptococcosis is a life-threatening disease that is seen commonly in acquired immunodeficiency syndrome (AIDS). We report a case of an HIV patient who presented with mild pleural effusion, multiple mediastinal, axillary lymphadenopathy with a low CD4:CD8 lymphocyte ratio, and favored clinically disseminated tuberculosis. Further cerebrospinal fluid (CSF) and tracheal aspirate have been done. Tracheal aspirate culture shows a fungal organism resembling Cryptococcus. Later, India ink staining on CSF highlighted the fungal organism Cryptococcus. Cytopathological investigation showed necrotizing inflammation along with fungal organisms, confirming the presence of cryptococcal lymphadenitis.
Insights
Cryptococcal meningitis, an opportunistic fungal infection, can present unusually in lymph nodes of HIV-infected individuals. This case highlights cryptococcal lymphadenitis mimicking tuberculosis in an AIDS patient.
Area of Science:
- Infectious Diseases
- Mycology
- Immunology
Background:
- Cryptococcal meningitis is a common opportunistic infection in individuals with human immunodeficiency virus (HIV).
- Lymph node involvement by Cryptococcus is rare and can be misdiagnosed as tuberculosis.
- Disseminated cryptococcosis is a severe, life-threatening condition frequently observed in acquired immunodeficiency syndrome (AIDS).
Observation:
- A case report of an HIV-positive patient presenting with pleural effusion and significant lymphadenopathy (mediastinal and axillary).
- The patient exhibited a low CD4:CD8 lymphocyte ratio, clinically suggestive of disseminated tuberculosis.
- Diagnostic investigations included cerebrospinal fluid (CSF) analysis and tracheal aspirate culture.
Findings:
- Tracheal aspirate culture revealed a fungal organism consistent with Cryptococcus.
- India ink staining of CSF confirmed the presence of Cryptococcus.
- Cytopathological examination showed necrotizing inflammation and fungal organisms, establishing a diagnosis of cryptococcal lymphadenitis.
Implications:
- This case underscores the importance of considering fungal infections, particularly Cryptococcus, in the differential diagnosis of lymphadenopathy in immunocompromised patients.
- Unusual presentations of cryptococcosis can mimic other infectious diseases like tuberculosis, necessitating comprehensive diagnostic approaches.
- Early and accurate diagnosis of cryptococcal lymphadenitis is crucial for timely treatment and improved patient outcomes in HIV/AIDS patients.
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