Gastric cryptococcal infection as an initial presentation of AIDS: a rare case report

Abstract

Cryptococcus neoformans has been recognized as a human pathogen over centuries. This has achieved new prominence in the recent years as it is an opportunistic fungi causing fatal, deep mycotic infections in immunocompromised states. Although cryptococcus is principally a pathogen of central nervous system, wide variety of other organs may also be involved. Gastrointestinal cryptococcosis is rarely reported either as an isolated finding or in a disseminated disease. However, even with the strikingly increased incidence of the disease, occurrence of obvious gastrointestinal symptoms directly attributable to cryptococcosis is outstandingly rare. We report a case of gastric cryptococcal infection with esophageal herpes as an initial presentation in an AIDS patient.

Gastric cryptococcosis: an unusual presentation of a common opportunistic disorder

“…The stomach is rarely the site of an opportunistic infection so that gastric cryptococcosis is an extremely rare complication. However, it may be the first clinical presentation of AIDS 2 , 3 . Gastric or gastrointestinal cryptococcosis may be clinically silent or present with nonspecific symptoms frequently attributable to other more prevalent disorders.…”

“…The clinical presentation of gastric cryptococcosis has been described as symptoms of “gastroesophageal reflux including odynophagia” 4 , “epigastric abdominal pain and biliary vomiting” 5 , “odynophagia and intractable vomiting” 3 , “acute worsening of chronic watery diarrhea with melena” 6 and “chronic dysphagia with epigastralgia” 7 .…”

“…Endoscopic and macroscopic pathologic findings of gastric cryptococcosis have been described as lesions of yellowish granular appearance 13 , as nodules 4 , as nodules with central erosions resembling inflammatory polyps 2 , as a circumscribed lesion with central umbilication 2 , as circumscribed nodules, some having central erosions resembling inflammatory polyps 2 , as irregular gastric ulcers, occasionally with red-pigmented lesions within the ulcer 6 and as gastric erosions 3 .…”

Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia

“…However, ulcers can be similar to those produced in malignancy, other infections (Cytomegalovirus, Toxoplasma gondii, Leishmania donovani, etc. ), or Crohn's disease [3,7,11,15].…”

Gastrointestinal cryptococcoma – Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?

“…C. neoformans classically is associated with central nervous system involvement. Lung involvement is common but frequently missed [9] , yet gastrointestinal involvement is rare [10] . Cryptococcus organisms can be acquired in the gut primarily through hematogenous dissemination [11] or less commonly through direct inoculation during paracentesis or via a neurosurgical shunt [12] .…”