Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/μL However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/μL who presented to the emergency department with fever and pancytopenia Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal The cerebrospinal fluid culture yielded Cryptococcus sp The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var grubii (genotype VNI) The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy The symptoms disappeared completely with recovery of white blood cells and platelets counts Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/μL

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Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV-infected patient: a case report.

Disseminated cryptococcosis is usually detected by cytological examination of fluids and histopathological examination of tissues and confirmed by fungal cultures. Here we report a case of unusual presence of cryptococcal organism engulfed by neutrophils and monocytes in the peripheral smear.

Detection of cryptococcosis in peripheral blood smear: A case report

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Detection of cryptococcosis in peripheral blood smear: A case report