Abstract
Cryptococcus is a serious opportunistic infection among human
immunodeficiency virus (HIV) positive people. Meningoencephalitis is the
most common manifestation of cryptococcal infection, while pulmonary
cryptococcosis is often neglected due to nonspecific clinical and
radiological presentation leading to a delay in diagnosis and
disseminated disease. Here, we reported a 67-year-old man with newly
diagnosed HIV who presented with concurrent cryptococcal
meningoencephalitis and pulmonary cryptococcosis that admitted with the
complaint of dyspnea and productive cough for 1.5 months, worsening
shortness of breath, fever and weight loss since 15 days prior to
admission. He also had severe oral candidiasis. Lung computed tomography
(CT) revealed ill-defined subpleural cavitary lesion in left lower zone
with bilateral diffuse ground glass opacity and air bronchogram. His HIV
PCR test was positive with absolute CD4 count less than 50 cells/mm3.
After starting antiretroviral therapy (ART), he gradually developed a
headache and decreased level of consciousness. Cerebrospinal fluid (CSF)
analysis revealed 450 cells, predominantly lymphocytes, with protein of
343mg/dl and glucose of 98 mg/dl (corresponding blood glucose 284
mg/dl). CSF India ink staining was positive for crypococcus spp.
Liposomal amphotericin B in combination with fluconazole (due to the
unavailability of flucytosin) was stated. He was intubated because of
hypoxia and his bronchoalveolar lavage was positive for Cryptococcus
spp. too. He died 2 weeks after starting antifungal therapy based on
this study it should be mentioned that neurologic and respiratory
symptoms may be the first presentation of acquired immunodeficiency
syndrome.