An exceptional case report of disseminated cryptococcosis in a hitherto immunocompetent patient

Abstract

Cryptococcosis is an opportunistic fungal infection causes significant disease predominantly in immunocompromised patients. Here we present an excepcional case of disseminated cryptococcosis with pulmonary and cerebral involvement in an immunocompetent patient with no apparent predisposing factors at the time of hospital admission. We described a case of an apparently immunocompetent 66-years old man admitted to hospital with a one-month history of cough, fever and vertigo. During hospitalization, thorax imaging was suggestive of lung metastasis, therefore, he went through several investigations. During hospitalization, he developed neurological symptoms and subsequently underwent a lumbar puncture. Cerebrospinal fluid (CSF) culture was positive for Cryptococcus spp. isolated on Sabouraud's dextrose agar and bird seed agar. In addition, the direct microscopy examination was positive for the India ink test, as well as with the latex agglutination test for cryptococcal polysaccharide antigen (CrAg) in CSF, while serum CrAg was negative. Despite the absence of classic immunocompromising features, he was treated with amphotericin B and fluconazole due to suspected disseminated cryptococcal infection. Later, he was diagnosed with prostatic adenocarcinoma. Upon successful completion of treatment for disseminated cryptococcosis, the patient underwent radical prostate ablation surgery as a treatment forprostatic adenocarcinoma. This exceptional case emphasizes the high degree of suspicion of atypical infections, and in these cases, it is particularly important to consider fungal infections in hitherto healthy patients with no apparent predisposing factors. Although Cryptococcus spp. is predominantly reported in patients with hematological malignancies, cryptococcosis investigation should also be considered as part of the initial workup of patients with a new diagnosis of a solid tumour prior to chemotherapy or radiotherapy.

Neurological vertigo in the emergency room in pediatric and adult age: systematic literature review and proposal for a diagnostic algorithm

“…et al, 2015 [ 30 ] Korea 33 to 73 years old Retrospective study 2003 to 2014 18 Presence of central vestibular signs allows bedside differentiation of isolated vestibular syndrome Parthasarathy R. et al, 2016 [ 31 ] Canada 76 years old Case report Not specified 1 Hypoperfusion to the flocculonodular lobe supplied by the anterior inferior cerebellar artery is likely a cause for intermittent vertigo Lee H. et al, 2002 [ 32 ] Korea 17 to 74 years old Prospective study March 2000 to July 2001 72 Migraine should be considered in the differential diagnosis of isolated recurrent vertigo of unknown cause Kim DD. et al, 2019 [ 33 ] Canada 60 s years old Case report 2019 1 Chronic naturopathic over- the-counter products intake may cause a subacute progressive cerebellar syndrome manifesting also with vertigo Adzic-Vukicevic T. et al, 2019 [ 34 ] Serbia 66 years old Case report 2019 1 Cryptococcosis may present even in immunocompetent patients and may show central nervous system involvement with vertigo Pula JH. et al, 2013 [ 35 ] USA 19 to 55 years old Prospective observational study 1999 to 2011 7 Multiple sclerosis is an uncommon cause of acute vestibular syndrome Kremer L. et al, 2014 [ 36 ] France, USA, UK, Japan, Canada, Germany Mean age 44.2 Prospective observational study Not specified 258 Br...…”

“…Other possible etiologies are demyelinating disorders, VM and VN [ 32 , 36 , 37 , 46 , 47 ]. Lastly, isolated vertigo in adults can be associated with genetic disorders, malformations, vascular diseases or psychological illness [ 22 , 33 , 34 , 39 , 42 , 48 , 49 ].…”

Cryptococcosis in Southern China: Insights from a Six-Year Retrospective Study in Eastern Guangdong

“…Similar to our study, some previous studies reported extra-pulmonary cryptococcoses in HIV-negative patients from different world regions. [34][35][36][37] Moreover, in 64.71% of patients, no apparent underlying diseases were reported. This is nearly similar to previous studies from China, in which 71% and 60% of cases showed no apparent risk factor.…”

Disseminated Cryptococcosis in an Immunocompromised Patient with Altered Mental Status and a Lung Nodule

“…Adzic-Vukicevic et al presented a case of a 66-year-old immunocompetent patient who presented with cough and vertigo whose chest imaging showed bilateral patchy opacities with nodules, initially concerning for metastasis, and subsequently became confused, had a lumbar puncture that was positive for Cryptococcosis. 7 Mada et al reported a case of a 56-year-old immunocompetent patient who presented with knee pain, magnetic resonance imaging (MRI) of the knee showed findings concerning for malignancy and pan-imaging showed a lung nodule, and fungal staining was positive for Cryptococcus neoformans . 8 …”