Disseminated Cryptococcal Infection in HIV-Infected Patients: A Retrospective Clinicopathological Review of 4 Autopsy Cases

Abstract

Cryptococcosis is an opportunistic infection with high mortality if not diagnosed and treated in time. The objective of this study was to review the clinicopathological information of decendents with final autopsy diagnosis of disseminated cryptococcal infection. This study collected data from 4 decendents who presented to an academic hospital/laboratory between 1 January 2015 to 31 December 2018. Their clinical, radiological and pathological findings including treatment were reviewed. Two decendents presented with respiratory symptoms whilst the other 2 presented with meningeal symptoms. Three were confirmed HIV positive. One decendent was on ART, one had defaulted treatment and one was ART naïve. Two decendents were diagnosed with cryptococcal meningitis, one with bacterial pneumonia and one with pulmonary tuberculosis. Three decendents died in emergency unit and one in the ward whilst on antifungal therapy. The autopsy findings confirmed disseminated cryptococcal infection in all cases. A high index of suspicion should be maintained in the right clinical context. Multi-organ involvement should be suspected in all patients and be actively sought out.

Keywords: Cryptococcosis; acquired immunodeficiency syndrome; autopsy; disseminated; human immunodeficiency virus.

Figure 1.

Chest X-ray: (A) widened mediastinum in keeping lymphadenopathy, (B) multiple reticulonodular infiltrates and left pleural effusion; Gross images, (C and D) lung with irregular and nodular surface (black circle and blue arrows) which is evident on cut surface (blue arrow); Microscopy: (E) acute suppurative inflammation of the lung and (F) necrosis.

Figure 2.

Brain: (A) gross features demonstrating widened sulci and flattened gyri with associated tonsilar herniation (black circle), (B) microcysts at the thalamus (red circle), (C) necrosis of the anterior commissure (black arrow) and (D) microscopic image showing soap bubble appearance.

Figure 3.

(A-G) Microscopy of affected organs. (A) Heart, (B) kidney, (C) liver, (D) bone marrow, (E) spleen, (F) lymph node, (G) thyroid; histochemical stains, (H) Periodic Acid Schiff (PAS) highlights the fungal yeast and (I) mucicarmine highlights thick mucinous capsule.