Gastrointestinal Cryptococcosis in immunosuppressed patients

Cryptococcus neoformans is a yeast-like fungus found in soil contaminated with avian droppings. It most often produces disseminated disease in immunocompromised hosts, particularly individuals with impaired T-cell mediated immunity such as those with HIV infection, patients receiving corticosteroids or other immunosuppressive therapy, and solid organ transplant recipients. The usual clinical manifestations are meningoencephalitis and pulmonary involvement, and it remains the most common systemic mycosis in patients with acquired immunodeficiency syndrome. Although the organism can involve nearly any organ, gastrointestinal cryptococcosis is exceedingly rare and has been described only in isolated case reports. Gastric and intestinal disease may present with acute abdominal symptoms or with more indolent features such as dyspepsia, nausea, vomiting, diarrhea, or melena. Diagnosis depends on endoscopic evaluation with histopathological confirmation, yet the condition is frequently unrecognized during life and is often identified primarily at postmortem examination. Reported endoscopic findings include ulcers, nodular lesions, and whitish petechiae. Prognosis is often poor, which highlights the need for early consideration of this entity in immunocompromised patients and prompt diagnostic evaluation given the absence of specific presenting features. This review summarizes susceptible host categories, the clinical spectrum of gastrointestinal cryptococcosis, diagnostic approaches, treatment considerations, and reported outcomes.