Disseminated cryptococcosis in a patient with idiopathic CD4 + T lymphocytopenia presenting as prostate and adrenal nodules: diagnosis from pathology and mNGS, a case report

Abstract

Disseminated Cryptococcosis infection typically occurs in immunocompromised patients, often manifested as pneumonia or meningoencephalitis. Cases with involvement of either prostate or adrenal glands are less frequent. We describe a case of an immunocompromised 62-year-old man with new-found Idiopathic CD4 + T lymphocytopenia who presented with urinary irritation symptoms followed by headache. The patient was finally diagnosed as disseminated cryptococcosis of prostate, adrenal gland involvement with the help of combining histopathology of formalin-fixed, paraffin-embedded tissue with metagenomic next-generation sequencing technique to identify C neoformans sensu stricto in prostate, adrenal gland tissues. Clinicians should be aware of atypical presentations of cryptococcal disease. In this case of cryptococcosis in immunocompromised patients, we find that cryptococcosis can affect varied organs simultaneously and should be considered in the differential of infectious diseases. And mNGS technology helps to confirm the diagnosis.

Keywords: Adrenal grand Infection, mNGS of FFPE.; Disseminated cryptococcosis; Idiopathic CD4 + T lymphocytopenia; Prostate.

Fig. 1

Multiple nodules found in MRI(upper left: adrenal gland, left bottom: spleen, upper right: prostate, right bottom: brain.)

Fig. 2

Pathology of prostate and adrenal gland.(A-C show prostate tissue and D-F show right adrenal gland. The arrows indicate the granulomatous inflammation. Figure 2A and D were magnified x10. Figure 2B, C, E, F were magnified x20.)