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Introduction: Cryptoccocus neoformans is an encapsulated fungal pathogen which is contracted through inhalation of the infectious organisms which cause primarily pulmonary disease. The infection remains latent until the host becomes immunocompromised. The disease may disseminate to different sites; however most patients essentially present with brain and lung disease (meningitis and pneumonia, respectively). Cryptococcal lymphadenitis is therefore an uncommon occurrence of this infection.
Objective: We describe the clinico-pathological features of an 18-year-old male with vertically transmitted HIV/AIDS infection who presented to our hospital with features of disseminated cryptococcal infection and notable lymph node involvement.
Case Presentation: An 18-year-old secondary school adolescent boy presented to our hospital with a 3-week history of fever, headache, body weakness and marked loss of body weight. He had been recently diagnosed with HIV infection and initiated on antiretroviral therapy (ART). On examination, he was weak, dehydrated and had multiple enlarged lymph nodes and facial skin papules. Notably, laboratory investigations revealed positive India ink test on cerebrospinal fluid (CSF) microscopy examination and culture, positive PAS stain for yeasts on lymph node histopathology and markedly prominent chest lymph nodes on the chest X-ray. A diagnosis of disseminated Cryptococcosis with lymph node involvement was made. He improved on Amphotericin B and oral fluconazole and a repeat CSF culture two weeks later was negative for Cryptococcus neoformans.
Conclusion: Cryptococcal lymphadenitis is a rare manifestation of Cryptococcal disease.
Srinivasan R, et al. Cryptococcal lymphadenitis diagnosed by fine needle aspiration cytology: A review of 15 cases. ActaCytol. 2010;54(1):1-4.
Bowen L, et al. HIV-associated opportunistic CNS infections: Pathophysiology, diagnosis and treatment. Nat Rev Neurol. 2016;12(11):662-674.
Morgan J, et al. Cryptococcus gattii Infection: Characteristics and Epidemiology of Cases Identified in a South African Province with High HIV Seroprevalence, 2002–2004. Clinical Infectious Diseases. 2006;43(8):1077-1080.
Kharsany A, Karim Q, HIV Infection and AIDS in sub-Saharan Africa: Current Status, Challenges and Opportunities. The Open AIDS Journal. 2016;10:34-48.
Kayirangwa E, et al. Current trends in Rwanda's HIV/AIDS epidemic. Sex Transm Infect. 2006. 82(1):27–31.
Bogaerts J, et al. AIDS-associated cryptococcal meningitis in Rwanda (1983-1992): Epidemiologic and diagnostic features. J Infect. 1999;39(1):32-7.
Perfect J. Cryptococcosis. Infect Dis Clin North Am. 1989;3(1):77-102.
Chandanwale S, et al. Cryptococcal supraclavicular lymphadenitis: A primary manifestation in AIDS-unusual presentation; 2018.
Antinori S, New Insights into HIV/AIDS-Associated Cryptococcosis. ISRN AIDS. 2013;471363.
Michaels S, Clark R, Kissinger P. Incidence and spectrum of AIDS-defining illnesses among persons treated with antiretroviral drugs. Clin Infect Dis. 1999; 29:468-469.
Dogbey P, Golden M, Ngo N. Cryptococcal lymphadenitis: An unusual initial presentation of HIV infection. BMJ Case Rep; 2013.
Shravanakumar B, et al. Cryptococcal Lymphadenitis Diagnosed by FNAC in a HIV Positive Individual. JPGM. 2003;49(4): 370.
Philip K, et al. Disseminated cryptococcosis presenting with generalized lymphadenopathy. J Cytol. 2012;29(3): 200-202.
Sethupathi M, Yoganathan K, Late onset of Cryptococcal cervical lymphadenitis following immune reconstitution inflammatory syndrome in a patient with AIDS. BMJ Case Rep; 2015.
Tahir M, et al. Immune reconstitution inflammatory syndrome in a patient with cryptococcal lymphadenitis as the first presentation of acquired immunodeficiency syndrome. J Postgrad Med. 2007;53(4): 250-2.
Kamana N, et al. Tuberculosis is the leading cause of lymphadenopathy in HIV-infected persons in India: Results of a fine-needle aspiration analysis. Scand J Infect Dis. 2010;42(11-12):827-830.
Srinivasan R, GN, Shifa R, Malhotra P, Rajwanshi A, ChakrabartiA. Cryptococcal lymphadenitis diagnosed by fine needle aspiration cytology: A review of 15 cases. Acta Cytol. 2010;54(1):1-4.
Verma A, Sinha S, Verma A, Cryptococcal lymphadenitis diagnosed on FNAC – Primary manifestation in AIDS patients. Int J Med Sci Pub Health. 2016;5(12): 2641-2.
Putignani L, et al. Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: A case report and review of the literature. Int J Immunopath Pharm. 2008;21(3): 751-6.
Shukla S, et al. Liver dysfunction as the presenting feature of disseminated cryptococcosis. S Afr J Infec Dis. 2016; 31(2):38-41.
Liu P, Yang Y, Shi Z. Cryptococcal liver abscess: A case report of successful treatment with amphotericin-B and literature review. Jpn J Infect Dis. 2009; 62(1):59-60.