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Granulomatous peritoneal cryptococcomas. An unusual sequela of disseminated cryptococcosis
S M Gordon1, A A Gal, J R Amerson
1Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Abstract:
We report an unusual case of fibrosing peritoneal cryptococcal granulomas in a 36-year-old human immunodeficiency virus-negative man with small-bowel obstruction who previously had been treated for cryptococcal meningitis. At laparotomy, multiple pinhead-sized granulomas studded the visceral peritoneum. Microscopic examination showed cryptococcal granulomas characterized by peripheral fibrosis and central caseous necrosis. On mucicarmine staining, the rare teardrop budding and prominent capsular staining were characteristic of Cryptococcus species. We surmise that this inflammatory reaction observed in the peritoneum represents a chronic tissue reaction that occurred during the previous cryptococcal infection.
Insights
This case study details fibrosing peritoneal cryptococcal granulomas, a rare complication in a patient previously treated for cryptococcal meningitis. The findings highlight a chronic inflammatory response in the peritoneum.
Area of Science:
- Medical Mycology
- Gastroenterology
- Pathology
Background:
- Cryptococcal meningitis is a serious fungal infection, typically affecting immunocompromised individuals.
- Previous treatment for cryptococcal meningitis can sometimes lead to unusual long-term complications.
- Small-bowel obstruction is a critical condition requiring prompt diagnosis and management.
Observation:
- A 36-year-old human immunodeficiency virus-negative male presented with small-bowel obstruction.
- During laparotomy, numerous small granulomas were observed on the visceral peritoneum.
- Histopathological examination revealed fibrotic granulomas with central caseous necrosis.
Findings:
- Microscopic analysis confirmed the presence of Cryptococcus species within the granulomas, evidenced by characteristic budding and capsular staining.
- The peritoneal lesions exhibited peripheral fibrosis, suggesting a chronic inflammatory process.
- The findings indicate a localized, chronic tissue reaction to a prior Cryptococcus infection.
Implications:
- This case underscores the potential for cryptococcal infections to manifest with unusual peritoneal involvement, even in immunocompetent individuals.
- It highlights the importance of considering prior infectious histories in the differential diagnosis of unexplained abdominal pathologies.
- The study contributes to understanding the spectrum of chronic inflammatory responses to fungal infections in serosal tissues.