Cryptococcal Immune Reconstitution Inflammatory Syndrome: An Unusual Presentation on the Tongue

Orofacial Cryptococcosis: A Challenging Clinical Report and a Systematic Analysis of the Literature

“…50 Oral cryptococcosis usually presents as multiple ulceration, nodules and a granulomatous appearance, with the palate and tongue being the main affected sites. 17,18,[20][21][22][23][24][25][26]28,[30][31][32]38,41,42,43 As in the current report, cryptococcal infection can also present with nonhealing tooth extraction wounds. 22,40 Najjar et al 23 documented an example of disseminated cryptococcosis involving the labial, nasal, and palatal regions in which the diagnostic difficulty was due to the concomitant presence of mature T/natural killer cell lymphoma.…”

“…Data on the oral manifestations of cryptococcosis are sparse in the literature, with 26 reports documented hitherto. 17,18,20–43 Men were affected in almost 85%, with a peak incidence in the fourth, fifth, and seventh decades of life. It is known that individuals vulnerable to cryptococcosis are those with advanced HIV/AIDS, either because they are unaware of their serological status or because they are not on adequate antiretroviral therapy.…”

“…62 Our review identified that Grocott-Gomori methenamine silver and mucicarmine staining were the most employed in the diagnosis. 17,21,22,[24][25][26][28][29][30][31]33,34,[36][37][38]40,41 Additionally, Fontana-Masson staining, which identifies melanin in the yeast cell wall, has also been used, but less frequently. 1,3 As demonstrated in the present study and others, 20,24,33 direct identification of globular and encapsulated cryptococcal yeast cells in body fluids is possible using India ink staining.…”

“…Serological tests with latex agglutination (n = 4) were used in serum and/or cerebrospinal fluid samples. 30,37,38,43 Regarding treatment, amphotericin B was used in 15 patients, associated with fluconazole (n = 10), flucytosine (n = 7), and ketoconazole (n = 1). Also, fluconazole (n = 6), itraconazole (n = 1), and ketoconazole (n = 1) were used as monotherapy.…”

“…Twenty-six studies comprising 26 affected individuals met the eligibility criteria and were analyzed. 17,18, The articles were from the United States, 17,[20][21][22][23][24][25][26]28,[32][33][34][35][36] Peru, 29 Brazil, 30 Colombia, 38 Trinidad and Tobago, 41 Argentina, 43 Germany, 27 The Netherlands, 18 Malaysia, 31 Japan, 37,40 Indonesia, 39 and Australia 42 (Table 2). The mean age of affected participants was 49 (±15.3) years, ranging from 25 to 81 years, with a peak in the fourth and fifth (n = 6/23%, each) and seventh (n = 6/ 23%) decades of life.…”