Disseminated cryptococcosis in a patient with newly diagnosed HTLV-1 infection

BMJ Case Rep. 2021 Jan 28;14(1):e235794. doi: 10.1136/bcr-2020-235794.

Abstract

Infection by human T-lymphotropic virus 1 (HTLV-1) is often seen as the cause of chronic infection or lymphoproliferative disorders, but many clinicians do not recognise its association with severe immunosuppression. We report the case of a woman in her 70s from the Caribbean who sought care at the emergency department for weakness, fatigue and weight loss. Further work-up showed atypical lymphocytosis with floral lymphocytes and smudge cells in the peripheral blood smear and hypercalcaemia. Chest CT demonstrated a moderate right pleural effusion. Results of HIV testing were negative, and screening and confirmatory tests for HTLV-1 were positive. Empiric antibiotic therapy was administered, and the patient was discharged home. Five days later, she was readmitted with shortness of breath and severe abdominal pain. A disseminated infection with Cryptococcus neoformans was diagnosed. Despite aggressive intravenous antifungal therapy, the patient died on day 7 of hospitalisation.

Keywords: cryptococcus; infectious diseases.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / therapeutic use
  • Ascites / diagnostic imaging
  • Cryptococcosis / complications
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / drug therapy
  • Emigrants and Immigrants
  • Fatal Outcome
  • Female
  • HTLV-I Infections / complications
  • HTLV-I Infections / diagnosis*
  • Haiti / ethnology
  • Human T-lymphotropic virus 1
  • Humans
  • Invasive Fungal Infections / complications
  • Invasive Fungal Infections / diagnosis*
  • Invasive Fungal Infections / drug therapy
  • Leukemia-Lymphoma, Adult T-Cell / complications
  • Leukemia-Lymphoma, Adult T-Cell / diagnosis*
  • Lymphadenopathy / diagnostic imaging
  • Pleural Effusion / diagnostic imaging

Substances

  • Antifungal Agents