Cryptococcus neoformans Meningitis With Renal Involvement in an HIV-Positive Patient: A Case Report

In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement. A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection. Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results. India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells. Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture. Liposomal amphotericin B and fluconazol was added to the treatment schedule. Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement. Antifungal therapy was continued as oral fluconazole after 40 days. Fluconazol was discontinued when CD4+ T cell count increased over 100/mm3 after 12 months. The patient had persistently elevated creatinin levels under ART without antifungal therapy. Last creatinine value was 2.4 mg/dL after a one-year follow-up. Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is <100/mm3 and the serum cryptococcal antigen is positive. In addition, cryptococcal infection should be considered in differential diagnosis of HIV-positive patients with impaired renal function and kidney biopsies should be performed as soon as possible. Early diagnosis will help to reduce mortality and morbidity. It should be kept in mind that cryptococcal infections in HIV-infected patients may be present with multiple organ involvement. Klimik Dergisi 2018; 31(2): 153-6.