Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV infected patient: a case report

Vechi, Hareton Teixeira; Theodoro, Raquel Cordeiro; Oliveira, Andrea Lima de; Gomes, Ronald Muryellison Oliveira da Silva; Soares, Rodolfo Daniel de Almeida; Freire, Munya Gandour; Bay, Mônica Baumgardt

Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV infected patient: a case report

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dc.contributor.author	Vechi, Hareton Teixeira
dc.contributor.author	Theodoro, Raquel Cordeiro
dc.contributor.author	Oliveira, Andrea Lima de
dc.contributor.author	Gomes, Ronald Muryellison Oliveira da Silva
dc.contributor.author	Soares, Rodolfo Daniel de Almeida
dc.contributor.author	Freire, Munya Gandour
dc.contributor.author	Bay, Mônica Baumgardt
dc.date.accessioned	2020-12-22T14:17:24Z
dc.date.available	2020-12-22T14:17:24Z
dc.date.issued	2019-03
dc.description.resumo	Background: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/μL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. Case presentation: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/μL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. Conclusions: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/μL.	pt_BR
dc.identifier.citation	VECHI, Hareton Teixeira; THEODORO, Raquel Cordeiro; OLIVEIRA, Andrea Lima de; GOMES, Ronald Muryellison Oliveira da Silv; SOARES, Rodolfo Daniel de Almeida; FREIRE, Munya Gandour; BAY, Mônica Baumgardt. Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV-infected patient: a case report. Bmc Infectious Diseases, [s. l.], v. 19, n. 1, p. 220-227, 4 mar. 2019. Springer Science and Business Media LLC. Disponível em: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3831-8. Acesso em: 16 out. 2020. http://dx.doi.org/10.1186/s12879-019-3831-8.	pt_BR
dc.identifier.issn	1471-2334 (online)
dc.identifier.uri	https://repositorio.ufrn.br/handle/123456789/31102
dc.language	en	pt_BR
dc.publisher	BMC	pt_BR
dc.rights	Attribution 3.0 Brazil	*
dc.rights.uri	http://creativecommons.org/licenses/by/3.0/br/	*
dc.subject	Cryptococcosis	pt_BR
dc.subject	Cryptococcus neorformans	pt_BR
dc.subject	AIDS	pt_BR
dc.subject	HIV	pt_BR
dc.subject	Bone marrow	pt_BR
dc.title	Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV infected patient: a case report	pt_BR
dc.type	article	pt_BR