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Disseminated Cryptococcal Disease of the Bone Marrow, Cerebrospinal Fluid and Blood in an ART-Naive Patient with Advanced HIV: A Case Report

Sumaiya Cassim, Monalisa Ntobongwana

Background: Cryptococcosis affects 10-30% of patients with acquired immunodeficiency syndrome (AIDS) resulting in significant morbidity and mortality. The primary sites of cryptococcal disease are the lung and central nervous system with bone marrow involvement being rare.
Case presentation: This case report describes a human immunodeficiency virus (HIV) positive, anti-retroviral therapy (ART) naïve female with pancytopenia who demonstrated no significant symptoms nor clinical signs as well as a negative serum cryptococcal antigen (CrAg) test. A bone marrow biopsy was then performed which resulted in a diagnosis of disseminated cryptococcal disease of the bone marrow. Blood and cerebrospinal fluid (CSF) fungal cultures confirmed the presence of Cryptococcus neoformans. The patient was then successfully treated with antifungal agents-amphotericin B and fluconazole.
Conclusion: Bone marrow examination may therefore be a useful method in early diagnosis of disseminated cryptococcosis as a cause of cytopenias in immunocompromised patients, thus enabling early appropriate treatment and improved outcomes.