Colonic cryptococcosis as a rare presentation in HIV infection: a case report and review of the literature

Abstract

Colonic cryptococcal infection is unusual in people living with HIV (PLWH) and even more so without concomitant neurological compromise. Published case reports describe diarrhea and other intestinal manifestations that are often confused with systemic tuberculosis infection. We describe an Peruvian woman living with HIV on antiretroviral therapy who presented hypotensive with a 6-month history of fever and epigastric pain, in addition to episodes of sporadic diarrhea. Due to the suspicion of systemic tuberculosis, antituberculosis treatment was started. Days later, without clinical improvement, colonoscopy revealed ulcers in the transverse colon. Histopathological examination of biopsied tissue was compatible with Cryptococcus spp. She received antifungal therapy with amphotericin B and fluconazole. Despite the treatment, the patient died six days later from multiple organ failure.

Colonic cryptococcosis presenting with chronic diarrhea in a person with advanced human immunodeficiency virus disease: a case report

“…6) The clinical presentation of GI cryptococcosis varies from no symptoms to symptoms similar to those of other GI infections, such as abdominal pain, diarrhea, fever, and weight loss; the diagnosis of GI cryptococcosis is often incidental or in autopsies. [7][8][9] In a retrospective review of 23 autopsied patients with pulmonary or disseminated cryptococcosis, 8/24 patients (33%) had gastrointestinal tract cryptococcal infection, and among them, the colon was affected in some. 3) Thus, it can be surmised that there may be more cases of colonic cryptococcosis that were not diagnosed.…”

“…5,10) Endoscopic findings at the affected site vary, including erythema, erosion, ulcers, or masses. 7,9) The inflammatory reaction is variable and depends on the host's immune status, ranging from a suppurative necrotizing inf lammatory reaction, often with granulomatous features, to virtually no reaction. 11) Treatment for non-meningeal extrapulmonary cryptococcosis is similar to that for CNS involvement:…”