Gastrointestinal cryptococcoma - Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?

Abdu K Musubire; David B Meya; Robert Lukande; Andrew Kambugu; Paul R Bohjanen; David R Boulware

doi:10.1016/j.mmcr.2015.03.004

Gastrointestinal cryptococcoma - Immune reconstitution inflammatory syndrome or cryptococcal relapse in a patient with AIDS?

Med Mycol Case Rep. 2015 Mar 26:8:40-3. doi: 10.1016/j.mmcr.2015.03.004. eCollection 2015 Jun.

Authors

Abdu K Musubire¹, David B Meya², Robert Lukande³, Andrew Kambugu⁴, Paul R Bohjanen⁵, David R Boulware⁵

Affiliations

¹ Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital, Kampala, Uganda.
² Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA ; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University and Mulago Hospital, Kampala, Uganda.
³ Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Infectious Disease Institute, College of health Sciences, Makerere University, Kampala, Uganda ; Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
⁵ Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.

Abstract

The introduction of antiretroviral therapy (ART) may lead to unusual paradoxical and unmasking presentations of opportunistic infections. Intra-abdominal cryptococcosis is a rare manifestation of Cryptococcus. We present the case of an HIV-infected patient on ART, with a history of cryptococcal meningitis who presented with subacute, worsening abdominal pain during immune recovery. This evolved into chronic abdominal pain, with thickened bowel, and abdominal lymphadenopathy, while receiving empiric tuberculosis treatment. At 6-months, he developed intestinal perforation due to a histologically confirmed cryptococcoma.

Keywords: AIDS; Antiretroviral therapy; Cryptococcal meningitis; Cryptococcoma; HIV; Immune reconstitution inflammatory syndrome.

Abstract

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