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Co-Infection of Pulmonary Aspergillosis and Cryptococcal Meningitis in an HIV-Positive Patient: A Case Report

Summary

This case describes a 46-year-old man with advanced HIV who developed two serious fungal infections simultaneously: a lung infection caused by Aspergillus fungus and meningitis caused by Cryptococcus fungus. Despite receiving appropriate antifungal medications, his condition worsened and he unfortunately died. The case highlights how people with very low immune cell counts are at high risk for multiple life-threatening fungal infections and emphasizes the importance of early HIV testing and screening for fungal infections.

Background

Opportunistic fungal infections (OFIs) are common among HIV-positive patients with low CD4 counts. While cryptococcosis and aspergillosis are individually documented in HIV/AIDS patients, co-infections of these two fungal pathogens are rarely reported in the literature.

Objective

To present a case report of simultaneous pulmonary aspergillosis and cryptococcal meningitis in a late-diagnosed HIV patient with severely compromised immune function (CD4 count <100 cells/μL).

Results

A 46-year-old homosexual male presented with productive cough, fever, and weight loss. Imaging revealed a cavitary lung lesion. Pathological examination and Aspergillus-specific PCR confirmed pulmonary aspergillosis. One month later, the patient developed meningitis symptoms; CSF analysis with Indian ink staining and Cryptococcal PCR identified Cryptococcus neoformans ST69 (molecular type VNI). Despite antifungal therapy with voriconazole and liposomal amphotericin B plus fluconazole, the patient died 24 hours after cryptococcal meningitis diagnosis.

Conclusion

This case demonstrates the vulnerability of advanced HIV-positive patients to multiple simultaneous opportunistic fungal infections. Implementation of WHO-recommended CrAg screening for HIV patients with CD4 ≤100 cells/μL and heightened clinical suspicion for co-infections are essential to improve outcomes in resource-limited settings.
  • Published in:Case Reports in Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 40801018, DOI: 10.1155/crdi/5630156
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