Systemic cryptococcosis in an immune-competent child

Abstract

Crytococcus neoformans is an encapsulated yeast that frequently affects immune-compromised patients, although increasingly being detected in the immune-competent host as well. We report a case of disseminated cryptococcosis in a young child in whom no immune deficiency was yet identified. A 4-year-old child presented with high-grade fever, intermittent abdominal pain and generalized skin eruptions for the past two months. He had pallor, firm lymphadenopathy, skin lesions with scarring and firm hepatosplenomegaly. Magnetic resonance imaging of brain and bone-marrow aspiration were normal. Fine-needle-aspiration-cytology of cervical lymph nodes demonstrated Cryptococcus. Serum latex-agglutination test showed a positive titer (1:256). Cryptococcus culture was sterile. The patient received intravenous liposomal amphotericin-B and oral flucytosine for 8 weeks followed by oral fluconazole. Disseminated cryptococcosis with involvement of reticuloendothelial and dermatological systems is rare. Early diagnosis and timely management of associated complications would be life saving.

Disseminated Cryptococcal Infection in Apparently Immunocompetent Child: a Case Report

“…As CSF was normal in our patient, the neurological signs were mistakenly ignored. Latex agglutination test for cryptococcal antigen in serum and cerebrospinal fluid has high sensitivity (> 90%) so titers above 1:4 in body fluids highly suggest infection [3,10]. In our case too, latex agglutination test for cryptococcal antigen should have been sent, especially in the background of CNS involvement with normal CSF and CT findings.…”

Disseminated and Relapsing Cryptococcosis: What We Still Have to Learn—a Case Series and Review of Literature

“…A possible and much rare cause could be the presence of sanctuary district for Cryptococcus where level of drugs remains too low to eradicate the fungus. 21 36 [44] 1 : 1 0 2 4 N o Ito, 2017 [21] 1 : 4 0 9 6 N o Chen, 2015 [45] 1 : 1 2 8 0 N o Haraga, 2018 [46] 1 : 2 5 6 N o Huang, 2015 [24] 1 : 1 2 8 N o Beji, 2017 [4] 1 : 1 6 0 0 N o Ni, 2013 [28] 1 : 1 0 2 4 N o Adzic-Vukicevic, 2020 [29] Negative No Sciaudone, 2010 [31] 1 : 2 5 6 N o Matsuda, 2011 [34] 1 : 2 5 6 N o Hung, 2010 [47] 1 : 5 1 2 N o CRAG titer is intended at the moment of diagnosis…”

Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

“…This is particularly useful for strains of Cryptococcus that have a diminished capsule, which may not be readily apparent with the mucicarmine stain. In the setting of apparently local disease; however, lumbar punctures remain important to assess for neurologic dissemination from lytic bone lesions ( 45 ) or skin lesions ( 46 ), as the organism has a strong neurological predisposition for infection.…”