Cryptococcal Pneumonia and Disseminated Histoplasmosis Coinfection in Newly Diagnosed HIV Patient

Abstract

INTRODUCTION: Case report CASE PRESENTATION: 27 y/o M originally from Ecuador , recently diagnosed with HIV presented with 3 weeks of shortness of breath, fever, hemoptpysis, pleuritic chest pain associated with 10 lb weight loss & night sweats. On presentation Chest X ray showed left lower lobe infiltrates and left mid chest cavitary lesion with air fluid level. The finding were confirmed on CT scan of chest. Serum Cryptococcal Antigen test came positive with titer of 1:256, with negative CSF cryptococcal antigen. Patient was started on broad spectrum antibiotics, Amphotericin, Bactrim and prednsione. Fungal smear from BAL showed Cryptococcus. CT abdomen showed significant hepatosplenomegaly and mesenteric lymphadenopathy. Urine histoplasma antigen was positive with titer of 1:19. All other work up for PCP and other opportunistic infection was negative. Patient continued to improve on Amphotericin B, later on switched to Itraconazole, and discharged home with itraconazole and Infection Disease clinic follow up DISCUSSION: 27 y/o M originally from Ecuador , recently diagnosed with HIV presented with 3 weeks of shortness of breath, fever, hemoptpysis, pleuritic chest pain associated with 10 lb weight loss & night sweats. On presentation Chest X ray showed left lower lobe infiltrates and left mid chest cavitary lesion with air fluid level. The finding were confirmed on CT scan of chest. Serum Cryptococcal Antigen test came positive with titer of 1:256, with negative CSF cryptococcal antigen. Patient was started on broad spectrum antibiotics, Amphotericin, Bactrim and prednsione. Fungal smear from BAL showed Cryptococcus. CT abdomen showed significant hepatosplenomegaly and mesenteric lymphadenopathy. Urine histoplasma antigen was positive with titer of 1:19. All other work up for PCP and other opportunistic infection was negative. Patient continued to improve on Amphotericin B, later on switched to Itraconazole, and discharged home with itraconazole and Infection Disease clinic follow up. CONCLUSIONS: This case highlights the fact that HIV patients with low CD4 count are at risk of dual opportunistic infection with histoplasmosis and cryptococcus pneumonia.