Cryptococcus Infection in an Immunocompetent Patient.

Cryptococcal meningitis is a fungal infection of the CNS, generally thought of as an opportunistic infection in those with T-cell immunodeficiencies including AIDS (usually with a CD4 count of less than 100), chronic steroid use, hematological malignancies, and transplant recipients. It can have irreversible CNS morbidity, including vision loss, intracranial hypertension, and cognitive decline. Diagnosis depends on cerebrospinal fluid (CSF) analysis, in which cultures and cryptococcal antigen are most sensitive. CSF PCR can also be done. Most patients have disseminated disease, and blood cultures are also positive. Outcomes remain guarded, with a poor prognosis (morbidity and high mortality) among survivors. This article presents a case of cryptococcal meningitis in an immunocompetent individual, where absolutely no identifiable risk factor was present.

A Rare Case of Pyriform Sinus Fistula in an Adult.

The pyriform sinus fistula is very rare in adults, and it can present as recurrent deep neck space infection and abscess formation. The fistula results due to failure of obliteration of the third and fourth pharyngeal pouches. The diagnosis is often challenging, even with standard imaging techniques. We present a case of a patient who developed recurrent neck space infection and abscess formation. She was found to have a pyriform sinus fistula with fluoroscopy esophagram, although it was not seen with a standard contrast-enhanced computed tomography scan of the neck.