[Cryptococcosis in acquired immunodeficiency syndrome (AIDS)]

Abstract

Cryptococcus neoformans is an infrequent but important cause of severe disease in immunodepressed patients, especially in those with AIDS. We refer the case of a 45 year old patient with clinical, epidemiological and serological patterns of HIV-induced infection in the course of which the patient suffered a subacute neurologic syndrome with fatal evolution. The diagnosis was made by isolation of Cryptococcus neoformans in CSF and in palpable lymph nodes by fine-needle aspiration biopsy. Cryptococcal antigen titer of CSF was 1:2560. Treatment was standardized in the administration of amphotericin B (0.3 mg/kg/day) and 5-fluocytosine (150 mg/kg/day) for a period of six weeks. Factors that suggested poor prognosis were: a positive india ink preparation before treatment, a high initial CSF antigen titer, low CSF leukocyte count and the presence of Cryptococcus neoformans at an extraneural site. Since diagnosis of cryptococcosis was made when prominent localizing symptoms and signs were found, an intensive culture and serologic screening would be necessary in every patient with AIDS in order to establish an earlier diagnosis.