An 80-year-old man with a rare disease manifestation of disseminated cryptococcosis

TL;DR

An 80-year-old man developed a rare form of cryptococcosis involving the eyes, lungs, and blood, without typical immune issues.

Contribution

This case highlights an unusual clinical triad involving disseminated cryptococcosis, autoimmune hemolytic anemia, and ocular involvement without meningitis.

Findings

The patient presented with acute panuveitis, autoimmune hemolytic anemia, and pulmonary cryptococcal infection.

Cryptococcus neoformans was confirmed via molecular diagnostics and vitreous humor isolation.

The case occurred without known immunocompromising conditions, suggesting a novel clinical association.

Abstract

We present an extraordinary manifestation of disseminated cryptococcosis in a man who developed a triad of acute panuveitis, autoimmune hemolytic anemia, and pulmonary cryptococcal infection. The patient exhibited progressive clinical deterioration with mediastinal lymphadenopathy, fever and severe hemolysis. Despite initial negative cryptococcal antigen testing, histopathological examination of a pulmonary nodule demonstrated yeast forms consistent with cryptococcal infection. The diagnosis was confirmed through molecular diagnostics and isolation of Cryptococcus neoformans from vitreous humor with subsequent positive antigen testing. No underlying immunocompromising disease was identified, although a low CD4+ count was found of unknown etiology. Therapeutic intervention comprised systemic high-dose fluconazole combined with intravitreal liposomal amphotericin B. This case exemplifies an unusual presentation of extrapulmonary cryptococcosis with isolated ocular involvement in the absence of meningitis, and suggests a potential association between cryptococcosis and autoimmune hemolytic anaemia.

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