HIV infection presenting as bone marrow cryptococcosis

Abstract

Disseminated cryptococcal infection is an uncommon initial manifestation in immunocompromised patients. We report a rare case of a 40-year-old female presenting with fever and burning epigastrium. Peripheral blood film revealed a leukoerythroblastic picture with thrombocytopenia. Bone marrow aspiration showed granulomas along with cryptococcal yeast forms. The ELISA test for detection of human immunodeficiency virus (HIV) antigen was positive. Disseminated cryptococcosis can develop as the first manifestation of HIV infection in previously healthy individuals and granulomas in such bone marrow aspiration smears are a valuable clue to an underlying opportunistic infection.

Successful Management of Cryptococcal Meningitis and Bone Marrow Infiltration in a Young HIV/AIDS Patient: A Case Report and Review of the Literature

“…The remaining case summarized in Table 1 involved a 46-year-old man with HIV and concomitant histoplasmosis infection of the bone marrow who did not survive [2]. This patient's older age at diagnosis, possible advanced stage of his multiple comorbidities, and concomitant histoplasmosis infection may have led to his death despite treatment, whereas the two reported cases of survivors past hospitalization and the present case were all less than 21 years old at diagnosis.…”

“…We identified seven English language case reports published since 1990 that specifically reported patients positive for Cryptococcus in the bone marrow [1–7]. Two studies were excluded as they were case reports of non-HIV patients, and two were excluded as they did not specify the cryptococcosis treatment regimen [1, 2, 5, 6]. We summarize the key features of three cases of Cryptococcus infection of the bone marrow in the literature in addition to this case report.…”

“…All three of these patients were treated according to variations in the guidelines for cryptococcal meningitis which include a two-week induction phase with amphotericin B and flucytosine or amphotericin B and fluconazole, depending on the availability and tolerance of flucytosine, and an eight-week antifungal consolidation phase [7]. Two of these case reports had patients who survived to discharge [2, 3].…”

Haematologic and Urologic Manifestations of Cryptococcus neoformans

“…A retrospective series from 1992 to 1996 reviewed 1225 bone marrow specimens from HIV patients, and of 31 specimens positive for mycobacteria and fungi, only one marrow grew C. neoformans [15]. Sparse case reports have identifed cryptococcal bone marrow infltration in a young immunocompetent male [16], a patient with a new HIV diagnosis [17], and a patient with previously diagnosed HIV 8 years prior who presented with a CD4 lymphocyte count of 26 cells/μL [18]. Despite the relative frequency of concomitant cryptococcal and HIV infections, cryptococcal bone marrow infltration remains rarely reported in the literature.…”