Progressive Cytopenia Developing during Treatment of Cryptococcosis in a Patient with HIV Infection and Bone Marrow Cryptococcal Infection

Abstract

Cytopenia is a common complication in patients with human immunodeficiency virus (HIV) infection. Identifying the cause is demanding because of the wide range of possible diagnoses. We herein report an HIV-infected patient with disseminated cryptococcosis involving multiple organs including the blood, brain, lungs, and bone marrow, who developed progressive pancytopenia after initiation of anti-fungal treatment with liposomal amphotericin-B (L-AMB) and flucytosine (5FC). The pancytopenia persisted despite early 5 FC discontinuation. A bone marrow biopsy revealed cryptococcal infiltration and the blood examination findings recovered quickly after resuming L-AMB. Thus, this HIV-infected patient's pathological findings and clinical course suggested that the primary cause of the pancytopenia was bone marrow cryptococcosis.

Acute promyelocytic leukemia with additional chromosome abnormalities in a patient positive for HIV: A case report and literature review

“…It is hypothesized that the occurrence of APL in HIV may be coincidental but certain authors suggest that incidence of APL is higher in HIV-infected patients ( 22 ). Cytopenia of patients with HIV infection is usually attributed to action of viruses and antiviral drugs, and the accompanying malignant tumors of the hematopoietic system are often ignored ( 23 ). Therefore, further assessment and monitoring of potential associations is needed to determine the cause of concomitant HIV and APL.…”