Disseminated Cryptococcosis in an HIV-Negative Young Malay Female with Underlying Mediastinal Hodgkin Lymphoma: Case Report and Review of Literature

Vol. 21 No. 6 (suppl) : 2026 (13-20)

Noor Hamidah Che Ali Noor Hamidah Che Ali
Chuan Hun Ding Chuan Hun Ding
 Mohd Nizam Tzar Mohd Nizam Tzar

Abstract
Cryptococcosis is mainly caused by Cryptococcus neoformans and Cryptococcus gattii, which form the Cryptococcus complex. The infection is closely related to the human immunodeficiency virus (HIV)-positive status of the patient and often leaving HIV-negative patients overlooked. This is particularly noticeable when patients have other concurrent illnesses that mask the seemingly inconspicuous symptoms of cryptococcal meningitis. The result is a late diagnosis, which leads to delayed treatment and a poorer prognosis for these patients. In addition, lymphoma patients undergoing chemotherapy face a double challenge, as both the disease and the treatment contribute to a weakened immune system, leaving them vulnerable to pathogenic and opportunistic infections. In this case report, we presented a 36-year-old Malay female, with no history of HIV infection but with underlying mediastinal Hodgkin lymphoma. She concurrently developed disseminated Cryptococcus neoformans infection and eventually succumbed to the infection.
Keywords : Cryptococcus; HIV-negative; Hodgkin lymphoma; meningitis,
Abstrak
Kriptokokosis biasanya disebabkan oleh Cryptococcus neoformans dan Cryptococcus gattii, yang membentuk kompleks Cryptococcus. Jangkitan ini berkait rapat dengan pesakit berstatus positif-'human immunodeficiency virus' (HIV) dan sering menyebabkan pesakit berstatus negatif HIV terabai. Keadaan ini lebih ketara apabila pesakit mempunyai penyakit serentak lain yang boleh menyembunyikan gejala meningitis kriptokokus yang kelihatan tidak begitu ketara. Hasilnya ialah kelewatan diagnosis yang membawa kepada kelewatan rawatan dan prognosis yang lebih buruk untuk pesakit ini. Selain itu, pesakit limfoma yang menjalani kemoterapi menghadapi cabaran berganda, kerana kedua-dua penyakit dan rawatan menyumbang kepada kelemahan sistem imun, menyebabkan mereka terdedah kepada jangkitan patogen dan oportunistik. Dalam laporan kes ini, kami membentangkan kes seorang wanita Melayu berusia 36 tahun, tanpa sejarah jangkitan HIV tetapi menghidapi penyakit limfoma Hodgkin mediastinal. Beliau mengalami jangkitan Cryptococcus neoformans yang merebak secara serentak dan akhirnya meninggal dunia akibat jangkitan tersebut.
Kata Kunci : Cryptococcus; HIV-negatif; limfoma Hodgkin; meningitis,

Correspondance Address
*Correspondence: tzar@hctm.ukm.edu.my; Tel: +603 91459534


Left: Gram stain showing round yeast cells with budding; Right: India ink preparation positive for encapsulated yeasts