An 80-year-old man with a rare disease manifestation of disseminated cryptococcosis

Abstract

We present an extraordinary manifestation of disseminated cryptococcosis in a man who developed a triad of acute panuveitis, autoimmune hemolytic anemia, and pulmonary cryptococcal infection. The patient exhibited progressive clinical deterioration with mediastinal lymphadenopathy, fever and severe hemolysis. Despite initial negative cryptococcal antigen testing, histopathological examination of a pulmonary nodule demonstrated yeast forms consistent with cryptococcal infection. The diagnosis was confirmed through molecular diagnostics and isolation of Cryptococcus neoformans from vitreous humor with subsequent positive antigen testing. No underlying immunocompromising disease was identified, although a low CD4+ count was found of unknown etiology. Therapeutic intervention comprised systemic high-dose fluconazole combined with intravitreal liposomal amphotericin B. This case exemplifies an unusual presentation of extrapulmonary cryptococcosis with isolated ocular involvement in the absence of meningitis, and suggests a potential association between cryptococcosis and autoimmune hemolytic anaemia.