DOI: 10.12890/2025_005875

Disseminated cryptococcosis: a diagnostic challenge in an immunocompromised patient

Authors

  • Paula Mesquita Internal Medicine Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal 0009-0001-9867-4526
  • Daniela Ribeiro Alves Internal Medicine Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal 0009-0008-9978-4787
  • Joana Martinez Infectious Diseases Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal 0000-0001-5272-7832
  • Mónica Mata Internal Medicine Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal
  • Ana Micaela Martins Infectious Diseases Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal 0000-0002-9781-4259
  • João Fonseca Internal Medicine Service, Local Health Unit of the Aveiro Region, Aveiro, Portugal 0000-0002-9264-190X

alex.mesquita1@hotmail.com

Keywords

Disseminated cryptococcosis, Crohn’s disease, immunocompromised patient, necrotizing granulomas, constitutional syndrome

Abstract

Background: Cryptococcosis is an opportunistic fungal infection that causes disseminated disease in immunocompromised patients. Peritoneal involvement is rare and diagnostically challenging.
Case report: A 76-year-old man with Crohn’s disease on infliximab and previously treated latent tuberculosis was admitted with constitutional symptoms and abdominal distention evolving over 5 months. Ultrasound revealed bilateral pleural effusion and ascites. Initial hypotheses—peritoneal carcinomatosis and tuberculosis—were excluded through computed tomography scan, laboratory tests, and exploratory laparoscopy with biopsy, which showed necrotizing granulomatous peritonitis. Disseminated cryptococcosis was confirmed by India ink staining, cultures from peritoneal and pleural fluids, and serum cryptococcal antigen. Cerebrospinal fluid analysis and ophthalmological evaluation excluded central nervous system and ocular involvement. Treatment with liposomal amphotericin B and flucytosine led to clinical improvement.
Conclusion: This case highlights the importance of considering cryptococcosis in the differential diagnosis of polyserositis in immunocompromised patients. Early diagnosis and antifungal therapy improve outcomes.

View the entire article

Downloads

References

  1. Gupta G, Fries BC. Variability of phenotypic traits in Cryptococcus varieties and species and the resulting implications for pathogenesis. Future Microbiol 2010;5:775-787. doi: 10.2217/fmb.10.44
  2. Marietto-Goncalves GA, Grandi F. Are all psittacine birds carriers of Cryptococcus neoformans? Mem Inst Oswaldo Cruz 2011;106:781. doi: 10.1590/s0074-02762011000600023
  3. Osawa R, Singh N. Colitis as a manifestation of infliximab-associated disseminated cryptococcosis. Int J Infect Dis 2010;14:e450-3. doi: 10.1016/j.ijid.2009.05.019
  4. Dave M, Purohit T, Razonable R, Loftus EV Jr. Opportunistic infections due to inflammatory bowel disease therapy. Inflamm Bowel Dis 2014;20:196-212. doi: 10.1097/MIB.0b013e3182a827d2
  5. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009;23:525-530. doi: 10.1097/QAD.0b013e328322ffac
  6. Black KE, Baden LR. Fungal infections of the CNS. CNS Drugs 2007;21:293-318. doi: 10.2165/00023210-200721040-00004
  7. Jongwutiwes U, Sungkanuparph S, Kiertiburanakul S. Comparison of clinical features and survival between cryptococcosis in human immunodeficiency virus (HIV)-positive and HIV-negative patients. Jpn J Infect Dis 2008;61:111-115.
  8. Zhang Z, Fan W, Yang G, Xu Z, Wang J, Cheng Q, et al. Risk of tuberculosis in patients treated with TNF-alpha antagonists: A systematic review and meta-analysis of randomised controlled trials. BMJ Open 2017;7:e012567. doi:10.1136/bmjopen-2016-012567
  9. Bennett JE, Dismukes WE, Duma RJ, Gallis H, Leonard J, Fields B, et al. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. N Engl J Med 1979;301:126-131. doi: 10.1056/NEJM197907193010303
  10. Barenfanger J, Lawhorn J, Drake C. Nonvalue of culturing cerebrospinal fluid for fungi. J Clin Microbiol 2004;42:236-238. doi: 10.1128/JCM.42.1.236-238.2004

Published

2025-10-22

Issue

Vol. 12 No. 11 (2025)

Categories

How to Cite

1.
Mesquita P, Ribeiro Alves D, Martinez J, Mata M, Martins AM, Fonseca J. Disseminated cryptococcosis: a diagnostic challenge in an immunocompromised patient. EJCRIM [Internet]. 2025 Oct. 22 [cited 2026 Nov. 3];12(11). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5875

Most read articles by the same author(s)