A rare case of pulmonary cryptosporidiosis associated with pulmonary tuberculosis in a patient with advanced HIV infection

Abstract

Cryptosporidium spp., an important food and waterborne protozoan pathogen, can cause severe diarrhea and extraintestinal manifestations in immunocompromised individuals. The case of a 75 -years old patient diagnosed as a late presenter with advanced HIV infection and multiple opportunistic illnesses associated to HIV: cryptosporidiosis, intestinal and pulmonary, Cytomegalovirus colitis and pulmonary tuberculosis is presented. Cryptosporidium parvum was identified in fecal sample and bronchoalveolar lavage using rapid tests, PCR diagnosis, and sequencing, the two sequences being identical. In spite of adequate treatment for all associated infections, including Nitazoxanide for Cryptosporidium spp. infection, antiretroviral therapy, and management in the intensive care unit, the patient evolution was unfavorable, without immune reconstitution, leading to death on the 30th day of hospitalization. This case describes a rare localization of pulmonary cryptosporidiosis in association with pulmonary tuberculosis in a patient with advanced HIV infection. Clinicians should be aware of the possible pulmonary localization of this opportunistic parasite in immunodeficient patients.