Disseminated cryptococcal infection in a patient with treatment-naïve chronic lymphocytic leukemia (CLL)

Abstract

We report a case of disseminated cryptococcosis in a treatment-naïve chronic lymphocytic leukemia (CLL) patient. A 60-year-old man presented with a two-week history of intermittent fevers, frontal headaches, night sweats, weight loss and multiple pink papules on hands and face. Cryptococcemia was found by blood culture unexpectedly. Further investigation confirmed cryptococcal meningitis and skin disease. He responded to two week amphotericin B and flucytosine followed by four-week amphotericin B and fluconazole, three-month high dose fluconazole (800 mg/day), and maintenance fluconazole (400 mg/day) thereafter. CSF pleocytosis persisted until day 203 while cryptococcal antigen in the CSF persisted at day 334 of treatment.

Keywords: Chronic lymphocytic leukemia; Cryptococcus.

Fig. 1

A. Rash on the patient’s hand upon initial presentation. B. Section of skin biopsy with hematoxylin and eosin stain, original magnification 20 × . C. Photomicrograph of the skin biopsy showing large numbers of yeast forms surrounded by a clear space, typical of the thick capsule of Cryptococcus. (Mucicarmine, magnification 63x, courtesy of Dr. Bruce Burns).

Fig. 2

Cerebrospinal fluid A. Yeast cells on day 14 of treatment and B. Degenerating yeast cells on day 334 of treatment. (May-Grünwald-Giemsa, original magnification 100x oil immersion.).