Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia

Abstract

Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.

Localized intestinal cryptococcosis and co‐parasitism in a juvenile dog

“…23,24 Intestinal lymphangiectasia with and without small intestinal oedema has been described in immunocompetent humans secondary to cryptococcosis. 25 It is also possible that lesions consistent with Cryptococcus may have been identified in other locations if biospies were performed in this case.…”

Endoscopic Findings of Gastric Cryptococcosis in an Immunosuppressed Patient

“… 1 Gastrointestinal cryptococcosis has been rarely reported in the literature and can affect the esophagus, stomach, duodenum, and colon. 6 , 7 The clinical presentation can be unspecific ranging from dysphagia, dyspepsia, epigastric pain, nausea, vomiting, and diarrhea to upper GI bleeding. 2 , 5 Our patient presented with persistent vomiting and epigastric pain, which has been reported before by Eyer-Silva et al 4 in a 34-year-old patient with a previous diagnosis of HIV and a low CD4 count.…”

Disseminated Cryptococcal Disease in A Patient With Chronic Chylothorax and a Pleurovenous Catheter, a Case Report With Autopsy Findings

“…The patient did have a negative fourth-generation HIV 1/2 antibody p24 antigen test. Lymphocyte loss from chronic chylothorax fluid removal and protein-losing enteropathy leads to a net immunosuppressed state [ 23 , 33 , 34 ] .…”

“…This patient’s dissemination pathway began with the immunocompromised state due to the secondary defects in humoral and cellular immunity. Lymphangiectasia associated with protein-losing enteropathy causes chylothorax via enteric lymphatic vessel leakage [ 23 ] . The patient received a pleurovenous shunt to remove fluid from the thorax into the central venous system via the inferior vena cava.…”