Incidental Finding of Cryptococcus on Prostate Biopsy for Prostate Adenocarcinoma Following Cardiac Transplant: Case Report and Review of the Literature

Abstract

Patient: Male, 62Final Diagnosis: Prostatic cryptococcosisSymptoms: Elevated PSAMedication: —Clinical Procedure: —Specialty: UrologyObjective:Unusual clinical courseBackground:Cryptococcus is the third most common invasive fungal organism in immunocompromised patients, including transplant patients, and usually involves the central nervous system and lungs, with a median time to infection of 25 months. We report a case of Cryptococcus of the prostate gland, found as an incidental finding on prostate biopsy for prostate adenocarcinoma, four months following cardiac transplantation.Case Report:A 62-year-old male African-American who had a cardiac transplant four months previously, underwent a six-core prostate biopsy for a two-year history of increasing prostate-specific antigen (PSA) levels, and a recent history of non-specific urinary tract symptoms. A prostatic adenocarcinoma, Gleason grade 4+4=8, was diagnosed on histopathology, and ‘foamy’ cells were seen in the biopsies. Histochemical stains, including Grocott methenamine silver (GMS), and periodic acid-Schiff (PAS) showed abundant round and oval 5–7 µm diameter fungal elements; mucicarmine highlighted the fungal polysaccharide capsule, diagnostic for Cryptococcus. Cryptococcal antigen detection was made by the latex agglutination test and cultures. We reviewed the literature and found 70 published cases (from 1946–2008) of Cryptococcus of the prostate gland, with only one previous case presenting five years following cardiac transplantation.Conclusions:Fungal infections of the prostate are rare, and occur mainly in immunocompromised patients. We present a unique case of prostatic Cryptococcus found incidentally at four months following cardiac transplantation. This case report highlights the need to consider atypical fungal infection as a differential diagnosis for prostatitis in immunosuppressed patients, including transplant patients.

Cryptococcal Prostatitis Forming Caseous and Suppurative Granulomas Diagnosed by Needle Biopsy: A Case Report

“…In previous reports, cryptococcal prostatitis has been mainly diagnosed from autopsy specimens, transurethral resection of prostate (TURP), prostatectomy, and prostatic fluid or urine cultures, and less often from a biopsy specimen. 16 It has also been reported that Cryptococcus infection is rarely diagnosed by a prostate biopsy. 3 Cryptococcus infection is known to develop granulomatous inflammation when the cell-mediated immunity is not impaired.…”

Screening for chronic prostatitis pathogens using high‐throughput next‐generation sequencing

“…Shah et al 18 incidentally found cryptococcosis during a prostate biopsy in a patient with prostate adenocarcinoma. Fungal infections of the prostate are rare and primarily occur in immunocompromised patients.…”

Cryptococcal infection in haematologic malignancies and haematopoietic stem cell transplantation

“…In the same review of cryptococcal infections in haematologic malignancies, 4% of patients had Cryptococcus in the GU system 28 . A recent case report and review of literature from 1946 to 2008 had identified 70 cases of cryptococcal prostatitis, and approximately 30% of patients had no prostatic symptoms 75 . Renal involvement is uncommon 65 .…”

“…28 A recent case report and review of literature from 1946 to 2008 had identified 70 cases of cryptococcal prostatitis, and approximately 30% of patients had no prostatic symptoms. 75 Renal involvement is uncommon. 65 The gastrointestinal tract can rarely be the site of infection.…”