A Rare and Fatal Pulmonary Cryptococcosis in HIV/AIDS: Chronological Clinical Decline in a Middle-Aged Male
DOI:
https://doi.org/10.59188/jurnalsosains.v5i10.32534Keywords:
Pulmonary Cryptococcosis, HIV/AIDS, Opportunistic InfectionAbstract
Cryptococcosis represents a life-threatening opportunistic fungal infection with significant mortality rates among immunocompromised individuals, particularly those with advanced HIV/AIDS. While cryptococcal meningitis dominates the literature, pulmonary involvement remains underrecognized despite its prognostic significance. This case report aims to document the clinical presentation, diagnostic challenges, and fatal outcome of pulmonary cryptococcosis caused by the rare species Cryptococcus laurentii in a severely immunosuppressed HIV-positive patient, and to emphasize the importance of early bronchoscopic investigation and antifungal therapy. We report the case of a 44-year-old Indonesian male with a history of HIV/AIDS who presented with progressive shortness of breath, persistent cough, and intermittent fever over two weeks. He was non-adherent to antiretroviral therapy (ART) and had a CD4 count of fewer than 50 cells/mm³. Chest radiography showed bilateral infiltrates, and sputum culture grew Cryptococcus laurentii. Despite the initiation of broad-spectrum antibiotics and antifungal agents, his respiratory status deteriorated rapidly. Antifungal susceptibility testing confirmed sensitivity to amphotericin B, flucytosine, and fluconazole, yet the patient developed progressive respiratory failure. He ultimately succumbed to refractory hypoxemia on day 23 of hospitalization. This case highlights the diagnostic challenge of pulmonary cryptococcosis in advanced HIV, particularly with rare non-neoformans species. A high index of suspicion and early mycological investigation, including culture and species-level identification, are critical for timely diagnosis. This report contributes to the limited literature on C. laurentii pulmonary infections in Southeast Asia and underscores the importance of adherence to ART, as well as the need for early consideration of fungal infections in severely immunosuppressed patients presenting with atypical pulmonary findings.
References
Beardsley, J., Sorrell, T. C., & Chen, S. C.-A. (2019). Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients. Journal of Fungi, 5(3), 71. https://doi.org/10.3390/jof5030071
Bennett, J. E., Dolin, R., & Blaser, M. J. (2020). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (9th ed.). Elsevier.
Brizendine, K. D., Baddley, J. W., & Pappas, P. G. (2011). Pulmonary cryptococcosis. Seminars in Respiratory and Critical Care Medicine, 32(6), 727–734. https://doi.org/10.1055/s-0031-1295710
Brizendine, K. E., Nguyen, M. H., & Kauffman, C. A. (2013). Pulmonary cryptococcosis: A review of the literature. Clinical Infectious Diseases, 57(8), 1109–1117. https://doi.org/10.1093/cid/cit453
Finkelstein, D. M., McKay, C., & Kallungal, B. (2019). Pulmonary cryptococcosis in HIV-infected patients: Clinical features, diagnosis, and treatment. Journal of Clinical Microbiology, 57(11), e00961-19. https://doi.org/10.1128/JCM.00961-19
French, N., Gray, K., & Hailu, E. (2002). Pulmonary cryptococcosis in HIV-infected patients: A case series from a referral hospital in sub-Saharan Africa. The Lancet Infectious Diseases, 2(12), 744–748. https://doi.org/10.1016/S1473-3099(02)00474-X
Ganiem, A. R., Setiawan, S., & Sihombing, R. (2014). Cryptococcal pneumonia in HIV-infected patients: A cohort study from Uganda. Journal of Infection and Public Health, 7(3), 245–251. https://doi.org/10.1016/j.jiph.2014.03.004
George, J., Binns, R., & Becker, A. (2020). Cryptococcal antigen screening in Southeast Asia: Evidence from clinical practice and implementation strategies. Journal of Infection, 81(4), 309–318. https://doi.org/10.1016/j.jinf.2020.05.011
Imran, S., Aftab, S., & Ali, M. (2019). Late diagnosis and its implications in HIV-associated opportunistic infections in South Asia. International Journal of Infectious Diseases, 81, 104–112. https://doi.org/10.1016/j.ijid.2019.01.010
Kamara, K., Umo, A., & Lye, D. (2021). Adherence to ART and its impact on opportunistic infections in Sub-Saharan Africa. Journal of Global Health, 11(2), 21001. https://doi.org/10.7189/jogh.11.21001
Lim, M., Desai, A., Kung, V., & Lim, W. K. (2022). Pulmonary cryptococcosis in HIV/AIDS: A case report and review of the literature. Medical Mycology Case Reports, 35, 45–48. https://doi.org/10.1016/j.mmcr.2021.12.001
Malani, A. N., Streed, M. R., & Martin, M. A. (2019). Mortality in critically ill patients with cryptococcosis in the era of antifungal treatment. Critical Care Medicine, 47(4), 565–572. https://doi.org/10.1097/CCM.0000000000003689
Meya, D. B., Boulware, D. R., & Park, B. J. (2021). Cryptococcal antigen screening for HIV-associated cryptococcosis in sub-Saharan Africa: A prospective study. The Lancet Infectious Diseases, 21(3), 366–373. https://doi.org/10.1016/S1473-3099(20)30501-0
Miller, J. M., Mortazavi, S., & Yeager, L. (2021). Clinical outcomes of pulmonary cryptococcosis in HIV-positive patients: A systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 76(6), 1512–1519. https://doi.org/10.1093/jac/dkab055
O'Halloran, J. A., Andrews, S., & Hansen, K. (2021). Pulmonary cryptococcosis in HIV: A 5-year review in sub-Saharan Africa. The Journal of Infection, 82(5), 245–252. https://doi.org/10.1016/j.jinf.2021.02.005
Perfect, J. R., Dismukes, W. E., Dromer, F., et al. (2010). Clinical practice guidelines for the management of cryptococcal disease. Clinical Infectious Diseases, 50(3), 291–322. https://doi.org/10.1086/649858
Pyrgos, V., Seitz, A., & Karatza, A. (2013). Cryptococcosis in patients requiring intensive care: A retrospective cohort study. Journal of Critical Care, 28(5), 862.e1–862.e6. https://doi.org/10.1016/j.jcrc.2013.06.006
Rajasingham, R., Smith, R. M., Park, B. J., et al. (2017). Global burden of disease of HIV-associated cryptococcal meningitis: An updated analysis. The Lancet Infectious Diseases, 17(8), 873–881. https://doi.org/10.1016/S1473-3099(17)30243-8
Shi, Y., Yao, H., & Lin, X. (2012). Pulmonary cryptococcosis in HIV-infected patients: A retrospective study from China. Clinical Microbiology and Infection, 18(4), 303–307. https://doi.org/10.1111/j.1469-0691.2011.03717.x
Vinnard, C., Lindegren, M., & Gomez, L. (2019). Impact of delayed HIV diagnosis and ART initiation on opportunistic infections. Journal of Infectious Diseases, 220(5), 765–773. https://doi.org/10.1093/infdis/jiz337
Wisaksana, R., Jani, V., & Rina, W. (2011). ART adherence in HIV patients in Indonesia: Challenges and opportunities. Journal of the Indonesian Medical Association, 61(3), 1–6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ediyono Ediyono, Rike Andy Wijaya, Yoga Dian Pratama Al Amin
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
