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IMAGE IN HEMATOTLOGY
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 211

Disseminated cryptococcal infection involving bone marrow


Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission01-May-2020
Date of Decision25-May-2020
Date of Acceptance01-Aug-2020
Date of Web Publication17-Nov-2020

Correspondence Address:
Dr. Vishal Mangal
Department of Internal Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_56_20

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How to cite this article:
Mangal V, Singh A, Manrai M. Disseminated cryptococcal infection involving bone marrow. J Appl Hematol 2020;11:211

How to cite this URL:
Mangal V, Singh A, Manrai M. Disseminated cryptococcal infection involving bone marrow. J Appl Hematol [serial online] 2020 [cited 2020 Dec 3];11:211. Available from: https://www.jahjournal.org/text.asp?2020/11/4/211/300769

A 36-year-old male, a case of human immunodeficiency virus infection, on second-line antiretroviral therapy (tenofovir, lamivudine, lopinavir, and ritonavir) since 2018, presented to our center with cough, fever, and dyspnea of 3 weeks duration. On examination, he had tachycardia, tachypnea, axillary lymphadenopathy, intermittent bilateral squeaks in the infrascapular regions, and hepatosplenomegaly. His laboratory evaluation revealed pancytopenia and serum creatinine of 123.7 μmol/L (reference range, 62–115 μmol/L). On high-resolution computed tomographic imaging of the chest, he had cavitating nodules in the right upper lobe and middle lobe with diffuse ground-glass opacities. His sputum for acid–fast bacilli and cartridge-based nucleic acid amplification test for Mycobacterium tuberculosis was negative. Bone marrow biopsy revealed foci of budding fungal yeast forms (red arrow) with the surrounding capsule, in the background of normal marrow elements (yellow arrow) measuring 8–20 μ consistent with Cryptococci on periodic acid– Schiff stain [Figure 1]. His blood culture showed the growth of Cryptococcus neoformans, and cryptococcal antigen was also positive in the cerebrospinal fluid. He was managed with liposomal amphotericin B (5 mg/kg/day) intravenous infusion in 5% dextrose over 120 min for 2 weeks. The patient responded well to the therapy, and the final diagnosis of disseminated cryptococcal infection was made. Cryptococcus has been increasingly seen as a pathogen with the growing incidence of acquired immunodeficiency syndrome. Cryptococcosis commonly presents with pulmonary system, central nervous system, or skin involvement. Bone marrow involvement of Cryptococci has been rarely reported.
Figure 1: Bone marrow biopsy (Periodic–acid Schiff stain, ×40). The red arrow showing a budding yeast cell with a peripheral halo. The yellow arrow showing normal marrow elements

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




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