[Disseminated Cryptococcosis with Eosinophilia and Elevated IgE in a Non-HIV-infected Patient]

Area of Science:

• Infectious Diseases
• Immunology
• Pulmonology

Background:

• Disseminated cryptococcosis typically affects immunocompromised individuals, particularly those with HIV.
• This report details a rare case in an apparently immunocompetent patient presenting with cryptococcal meningitis, pneumonia with eosinophilia, and concurrent pulmonary tuberculosis.

Observation:

• A rare case of disseminated cryptococcosis, including meningitis and eosinophilic pneumonia, occurred in an apparently immunocompetent 33-year-old woman.
• The patient also developed pulmonary tuberculosis during the course of her illness.
• Diagnosis was confirmed by transbronchial lung biopsy showing yeast-like fungi and positive cerebrospinal fluid culture.

Findings:

• The patient presented with a diffuse micronodular pneumonia pattern, followed by meningitis.
• Peripheral blood and bronchoalveolar lavage fluid showed eosinophilia.
• Co-infection with Mycobacterium tuberculosis was identified, which resolved with anti-tuberculosis treatment.
• Cryptococcal meningitis was challenging to treat, with persistent elevated cerebrospinal fluid pressure despite standard induction therapy.
• Addition of flucytosine and repeated lumbar punctures ultimately led to full recovery.

Implications:

• This case suggests that disseminated cryptococcosis can occur in immunocompetent individuals, challenging typical clinical assumptions.
• The co-occurrence of cryptococcosis and tuberculosis in this patient underscores the complexity of diagnosing and managing opportunistic infections.
• Eosinophilia in pulmonary manifestations may be associated with cryptococcosis.
• Treatment of cryptococcal meningitis may require combination therapy, including flucytosine, especially in complex cases with elevated intracranial pressure.
• An underlying allergic condition might have predisposed the patient to disseminated cryptococcosis.