Two Cases of Cryptococcuria Developed as Isolated Cryptococcuria and Disseminated Cryptococcosis

Abstract

Cryptococcus is an opportunistic pathogen that mainly affects immunocompromised hosts and, less frequently, immunocompetent hosts. It causes serious morbidity and mortality due to systemic infections such as meningoencephalitis and pulmonary infection. Urinary involvement of Cryptococcus is sometimes reported among cases of disseminated cryptococcosis in AIDS patients, but no such reports have been published in Korea. We report two cases of cryptococcuria that developed in a 71-year old female with diabetes and liver cirrhosis and in a 50-year old male who received a liver transplant due to HBV-associated hepatic failure. The female patient had received prednisolone for 12 days before we detected C. neoformans in urine culture. Even though no antifungal therapy was indicated for cryptococcuria, following urine culture became negative, but still positive for cryptococcal antigen on hospital day 25. Her blood, CSF culture, and antigen tests were negative, and therefore she was diagnosed with isolated cryptococcuria. The male patient had received prednisolone and tacrolimus for 10 days before sputum and urine cultures became positive for C. neoformans. He had ill defined nodules and pleural effusion in both lungs on chest CT. His cryptococcuria was sustained for over 2 months, despite receiving amphotericin B treatment. His cryptococcuria seemed to be a symptom of disseminated cryptococcosis. (Korean J Clin Microbiol 2011;14:148-152)

Hidden in plain sight: urinary Cryptococcus neoformans missed by routine diagnostics in a patient with acute leukemia

“…neoformans . Cryptoccocuria is a rare clinical entity that is typically associated with systemic cryptococcal disease and has been described in both immunocompromised and in immunocompetent hosts [ 19 ]. In one retrospective analysis of 58 cases of cryptococcuria, 46 (79.3%) had a CrAg positive in CSF and 39 (67.2%) in blood.…”

First report of cryptococcuria in a bitch from India: a case report

“…As the routine examination of urine involves microscopic identification and not through growth in cultures or molecular tests, cryptococcuria in animals can be missed or misdiagnosed as Candida sp. (Bae et al 2011). This will lead to improper treatment, antifungal resistance, and prolonged evolution of the disease.…”

“…Cryptococcuria is a relatively uncommon presentation, and only a few sporadic cases have been described in humans suffering from underlying conditions like HIV, diabetes mellitus and systemic lupus erythematosus (SLE) (Kiertiburanakul et al 2004;Bae et al 2011). While there are no reported cases of cryptococcuria in dogs, it has been described in cats from manifestation of disseminated infection (Chapman and Kirk 2008).…”

Very early‐onset ofCryptococcus neoformansdisease following liver transplantation: Report of two cases and a review of the literature

“…Case 1 had new‐onset headaches prior to transplantation and a (subsequently found) CrAg of 1:8. Cryptococcosis was not initially suspected, and the diagnosis was surprisingly made by the presence of cryptococcuria, which often signifies hematogenous spread and disseminated cryptococcal infection prompting assessment for cerebral involvement. For case 2, the clinical presentation of cryptococcal infection was more typical; however, there were no clinical clues pre‐transplant as to the presence of cryptococcal infection, and a low‐positive cryptococcal antigen titer of 1:2.…”