Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus

Abstract

Background: Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus Cryptococcus, is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. Case Report:We report the case of a 28-year-old male with HIVwho had a simultaneous co-infection with cryptococcal meningitis and Mycobacterium avium complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine.Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Conclusion: Concurrent infectionwith cryptococcosis andMAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.