Non-meningeal, non-pulmonary disseminated intra-abdominal cryptococcosis in immunocompromised host: case report and approach to therapy

The most common presentation of Acquired Immuno-Deficiency Syndrome (AIDS) associated cryptococcosis is meningitis. Non-meningeal and non-pulmonary Cryptococcosis is very rare. We present a case of 16-year-old boy who presented to the Emergency Department with chief complaints of fever and pain abdomen involving left hypochondrium for 2 months. On evaluation, he was found to be HIV positive with very low CD4 count and had splenic abscess along with mesenteric lymphadenopathy. Fine needle aspiration cytology from the splenic abscess showed scattered multinucleated giant cells containing many rounded capsulated organisms within the cytoplasm. Alcian Blue-Periodic Acid Schiff stain (AB-PAS) highlighted the capsulated organisms as Cryptococcus neoformans. The patient was treated successfully with liposomal amphotericin B and flucytosine, followed by fluconazole along with antiretroviral therapy.