LYMPHADENOPATHY IN A YOUNG FEMALE: DISSEMINATED CRYPTOCOCCOSIS IN AN OTHERWISE HEALTHY HOST

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

Journal of General Internal Medicine

Abstract

CASE: A 30 year old female with past medical history of mild intermittent asthma presented with subacute sinus congestion, left sided facial swelling, and fever. On presentation, she was febrile and tachycardic, with cervical lymphadenopathy. The remainder of the physical exam was unremarkable. Computed Tomography of the face, mandible, and soft tissue neck showed suppurative retropharyngeal lymph nodes and air-fluid level within the left maxillary sinus consistent with acute sinusitis. Rhinoscopy was performed with drainage of maxillary sinus fluid, with cultures revealing Cryptococcus neoformans. Repeat Computed Tomography of soft tissue neck showed worsening lymphadenopathy with several necrotic lymph nodes. Incision and drainage and washout of the neck was performed, and pathology from specimen later revealed Cryptococcus neoformans. Serum Cryptococcal antigen resulted positive, and patient was started on induction therapy with amphotericin and flucytosine for disseminated cryptococcal infection. Lumbar puncture to assess for central nervous system involvement was negative. Evaluation for immunodeficiency including Human Immunodeficiency Virus, Sarcoidosis, Immunoglobulin deficiencies, or many autoimmune disorders were all performed and the only positive finding was mildly elevated serum Immunoglobulin E level. IMPACT/DISCUSSION: Cryptococcosis is acquired by inhalation of soil containing the encapsulated yeasts and thus, most commonly infects the lungs. Other commonly infected organs in disseminated disease include brain and meninges, skin, long bones, joints, liver, spleen, and kidneys. Cryptococcal infection is diagnosed with culture of C. neoformans, and disseminated disease is diagnosed when there is involvement of two noncontiguous areas of infection. Once disseminated cryptococcosis is diagnosed, it is recommended to perform a lumbar puncture to assess for central nervous system involvement as this can change the antifungal therapy chosen and the duration of therapy. CONCLUSION: This case showcases an uncommon presentation of disseminated Cryptococcus neoformans infection in an otherwise healthy patient. Though cryptococcosis, especially disseminated disease, is primarily an opportunistic pathogen known to mainly affect immunocompromised populations, it is important to keep this deadly pathogen on the differential for immunocompetent individuals with lymphadenopathy. Disseminated disease can be diagnosed when two or more different sites are affected, and impacts the therapy chosen for treatment of the infection.

Volume

37

Issue

Suppl 2

First Page

S479

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