Case Report: Cryptococcal eosinophilic meningitis in a patient with Hodgkin lymphoma.

Cryptococcal meningitis is the most common fungal meningitis in clinical practice. It primarily occurs in immunocompromised people and is typically associated with human immunodeficiency virus (HIV) infection. In rare cases, it is associated with Hodgkin lymphoma (HL). Eosinophilic meningitis (EM) is characterized by increased eosinophils in the cerebrospinal fluid (CSF) and is often caused by a parasitic infection of the central nervous system (CNS). EM caused by cryptococcal infection is rare; only four cases have been reported in the past 30 years. Here, we report a case of cryptococcal meningitis in a patient with HL who presented with an atypical eosinophil-predominant CSF cytology response. The patient's eosinophil proportion reached 91%; a proportion this high has not been reported previously and may be associated with HL. After antifungal therapy and tumor chemotherapy, the proportion of eosinophils decreased significantly. This case shows that cryptococcal meningitis and HL may be simultaneously contributing to CSF eosinophilia. HL should be considered in patients with eosinophilic cryptococcal meningitis and multiple adenopathies.

Disseminated Cryptococcosis in an Immunocompetent Child.

Disseminated cryptococcosis in children is a classic affliction associated with human immunodeficiency virus (HIV) infection or primary inherited immunodeficiency disorders (PID) with central nervous system being the most common site of dissemination. We report a rare case of disseminated cryptococcosis in an 11-year-old girl who presented with pulmonary involvement, hepatosplenomegaly, and generalized lymphadenopathy. No known inherited or acquired immune deficiencies were identified after a comprehensive laboratory work-up including genetic sequencing. She responded well to anti-fungal therapy (flucytosine and amphotericin followed by fluconazole) and is on regular follow-up.

An unusual manifestation of an HIV patient with Fungimea presenting with Cryptococcal Lymphadenitis

Introduction@#Cryptococcus neoformans (C. neoformans) is a fungus which infects the lungs, meninges, skin and the nervous system. In tropical countries prevalent with tuberculosis (TB), initial clinical presentations of a C. neoformans infection can normally be mistaken as a TB infection. The C. neoformans infection shall then form part of the differential diagnosis. Exposure to C. neoformans does not usually manifest as an infection however, in immunocompromised patients this results to cryptococcosis.@*Case@#This is a case of a 33-year-old male who was admitted due to febrile seizures. He was suspected to be in an immunocompromised state due to multiple sexual partners. A non-tender, mobile left cervical lymphadenopathy was subjected to FNAB (fine needle aspiration biopsy) surprisingly came out to be cryptococcal in nature. He was managed as a case of disseminated cryptococossis with meningeal extension. He was given amphotericin B and fluconazole.@*Conclusion@#The most common suspected cause of lymphadenitis in the Philippines is attributed to TB. The high index of suspicion based on sound medical history and physical examination can lead the clinician into considering an uncommon cause of lymphadenopathy most especially in patients with high likelihood of immunocompromised state.

Clinicopathological features of cryptococcal lymphadenitis and a review of literature.

Cryptococcosis is an invasive fungal infection in immunocompromised patients. The clinicopathological characteristics of cryptococcal lymphadenitis are not well known. We analyzed three cases of cryptococcal lymphadenitis and compared their characteristics with those in previous reports. Two patients were human immunodeficiency virus (HIV) carriers, and one patient was a human T-cell leukemia virus type-1 (HTLV-1) carrier. The age of the HTLV-1 carrier with cryptococcosis was much higher than that of the HIV-1 carriers. CD4-positive cell counts in peripheral blood were 5.8/µL (Case 1) and 79.9/µL (Case 2) in the HIV carriers and 3285/µL in the HTLV-1 carrier (Case 3). According to flow cytometric analysis of the lymph nodes of Cases 1, 2, and 3, 50.0%, 87.1%, and 85.9%, respectively, of the T-cells were CD3; 9.8%, 16.3%, and 75.8%, respectively, were CD4; and 35.5%, 77.3%, and 10.2%, respectively, were CD8. Cryptococcus neoformans was detected in tissue culture in all patients. Although gelatinous lesions and numerous fungal cocci were observed in the two HIV patients, the granuloma formation was small. Gelatinous formation and granuloma formation were observed in the HTLV-1 carrier. Necrosis was observed in all cases. In previous reports, granuloma formation, epithelioid cells, and necrotic lesions were observed in most cases. Most of the patients were also immunosuppressed. However, no HTLV-1 carrier was detected. In conclusion, lymphadenopathy in a HTLV-1 carrier may suggest the presence of cryptococcal lymphadenitis. The frequency of cryptococcosis in HTVL-1 carriers may increase with increase in the long-term survival rate of HTLV-1 carriers.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A Case Report on Cryptococcal Lymphadenitis in an Immunocompetent Adult Patient / 감염과화학요법

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients, but cryptococcal lymphadenitis is rare. We have experienced a case of cryptococcal lymphadenitis in an immunocompetent adult patient who presented with cervical lymphadenopathy and fever that did not subside for 3 weeks. Neck and chest CT scan showed multiple lymph node enlargements with central low density and peripheral enhancement on both hilar, mediastinal, and right supraclavicular areas. Cryptococcus lymphadenitis was diagnosed by tissue biopsy, PAS and GMS stain, and culture. This case emphasizes that when an immunocompetent patient presents with lymphadenopathy, cryptococcal lymphadenitis should always be considered in the differential diagnosis.

A case of cryptococcal lymphadenitis

No abstract available.