Disseminated cryptococcosis with recurrent multiple abscesses in an immunocompetent patient: a case report and literature review

Abstract

Background Cryptococcus neoformans is frequently present as an opportunistic pathogen mainly affecting immunocompromised populations. Disseminated C. neoformans infection in immunocompetent population is rare and usually involves lung and central nerve system. Cryptococcus from biologic samples can easily grow on routine fungal and bacterial culture media. Besides, cryptococcal latex agglutination test has been established as a reliable diagnostic tool with overall sensitivities of 93–100%.Case presentationWe report a rare disseminated cryptococcosis case which presented with chronic recurrent multiple abscess in an immunocompetent male involving skin, lung, spine and iliac fossa without evidence of central nerve system involving. The results of serum cryptococcal latex agglutination tests and standard microbial cultures were negative. The patient underwent empirical anti-bacterial and anti-tuberculosis therapy which turned out to be effectless. Finally, bedside inoculation of the pus was carried out and revealed Cryptococcus neoformans, which was confirmed by polymerase chain reaction. After the administration of anti-fungal drugs including liposomal amphotericin B, the patient recovered from fever and paraplegia.ConclusionsThis case reveals an uncommon pattern of disseminated C. neoformans infection in immunocompetent population presented with chronic multiple abscess and without central nerve system involving. Negative routine microbial cultures may not necessarily rule out cryptococcosis, especially in early stage. Besides, cryptococcal latex agglutination test does have a chance of false negative, which might be related with “capsule-deficiency”. Moreover, this phenomenon could be related with low-grade virulence and relative long illness duration.

Cryptococcus infection with asymptomatic diffuse pulmonary disease in an immunocompetent patient: A case report

“…C. gattii usually causes disease in immunocompetent persons and behaves as a primary pathogen. The percentage of C. gattii infection in immunocompetent hosts is significantly higher than that of C. neoformans infection[ 12 ] .…”

Cryptococcus: A Rare Cause of Parotid Abscess in Liver Cirrhosis

“…One report suggested a mortality rate of 81.2%, with most deaths directly attributable to cryptococcal infection and with over half of deaths occurring within 2 weeks after diagnosis [4]. Cryptococcal infection and abscess formation can affect almost any part of the body, with reports of bone, skin, intramuscular, cerebellar, brain stem, retropharyngeal, prostatic, ocular, breast, thyroid, ovarian, and mediastinal abscesses seen in the literature [16][17][18][19][20][21][22][23][24][25].…”

Disseminated cryptococcosis presenting with cutaneous involvement in an immunocompromised patient

“…Cryptococcus neoformans is an encapsulated yeast that causes cryptococcosis and colonizes pigeon excrement, soil, and dust [1][2][3]. It most often affects patients with impaired cell-mediated immunity, such as those with HIV [3].…”

“…The lungs are usually the primary site of infection, where it can remain localized or spread hematogenously to other organs such as the central nervous system (CNS) and skin [3][4][5]. Disseminated C. neoformans infection in immunocompetent individuals is extremely rare and usually involves the lungs and CNS [1,6]. Cutaneous cryptococcal infection can be an early sign of disseminated disease or it can occur via primary inoculation [3][4][5].…”