Disseminated cryptococcosis in a patient with nephrotic syndrome

Department of Nephrology, The Sindh Institute of Urology and Transplantation, DOW, Medical College and Civil Hospital, Karachi - 74200, Pakistan.
Indian Journal of Medical Microbiology (Impact Factor: 0.88). 05/2006; 24(2):141-3. DOI: 10.4103/0255-0857.25209
Source: PubMed


Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared.

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    • "Among HIV negative patients with disseminated disease, Cirrhosis was the most frequent predisposing condition and was associated with grave prognosis [10] . There are reports of disseminated cryptococcosis in HIV negative patients presenting as extensive subcutaneous nodules in renal transplant patients [11] , and patients with nephritic syndrome [12] . It can also present as intracranial granuloma [13] , necrotizing fasciitis [14] or with multiple osseous involvement [15] . "
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    ABSTRACT: Objective: To study disseminated cryptococcal infection in a tertiary care hospital in Southern India. Methods: The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed. Results: 7(58.3%) presented with fever < 30 days and 3(25%) > 30 days whereas 2(16.7%) did not have fever. All the 12(100%) had headache, 2(16.7%) had altered sensorium, one (8%) seizure. 5(41.7%) had diarrhea and vomiting. 6(50%) had oral candidiasis, and anemia. 9(75%) had elevated erythrocyte sedimentation rate (ESR). 6(50%) had neck stiffness. Cerebrospinal fluid (CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neoformans(C. neoformans) in 11(91.7%) and CSF culture positive in all 12 (100%), one (8%) had urine culture positive. India ink preparation was positive in 10(83.3%). CD4 count was less than 50/microl in 4 (33.3%), between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200. 6(50%) were treated with parenteral amphotericin B (0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d. 5(41.6%) were treated with fluconazole alone. 8(66.7%) improved and 4(33.3%) patients died. Among those who succumbed to the illness, 2(16.7%) received amphotericin and fluconazole, 2(16.7%) patients received fluconazole alone. Conclusions: Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non-HIV individuals. At times, its presentation closely mimics that of Tuberculosis. Early diagnosis and appropriate treatment should be started as early as possible.
    Preview · Article · Oct 2010 · Asian Pacific Journal of Tropical Medicine
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    ABSTRACT: Cryptococcus neoformans has a worldwide distribution. Meningoencephalitis is the most common manifestation of cryptococcosis. The outcome of a patient with cryptococcal infection depends on the immune status of the host. Patients with nephrotic syndrome are particularly susceptible to cryptococcal infection not only due to innate changes in their immune system but also because of the immunosuppressive agents used in the treatment. We report an 8-year-old boy with nephrotic syndrome, who developed cryptococcal meningitis and died of fulminant intracranial hypertension.
    No preview · Article · Jul 2011 · Indian Journal of Critical Care Medicine
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    ABSTRACT: We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.
    No preview · Article · Apr 2012 · Indian journal of medical microbiology
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