Journal of Applied Hematology

: 2020  |  Volume : 11  |  Issue : 4  |  Page : 211-

Disseminated cryptococcal infection involving bone marrow

Vishal Mangal, Anurag Singh, Manish Manrai 
 Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Correspondence Address:
Dr. Vishal Mangal
Department of Internal Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra

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

How to cite this URL:
Mangal V, Singh A, Manrai M. Disseminated cryptococcal infection involving bone marrow. J Appl Hematol [serial online] 2020 [cited 2021 Apr 20 ];11:211-211
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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}

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