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Mediastinal cryptococcoma as part of disseminated cryptococcosis in HIV-negative pregnant woman with Myasthenia Gravis: Autopsy case report

Summary

A 29-year-old pregnant woman with myasthenia gravis, a condition requiring long-term immune-suppressing medications, died from a widespread fungal infection caused by Cryptococcus. Despite being HIV-negative, her weakened immune system made her vulnerable to this serious infection. An autopsy revealed the infection had spread throughout her body, including her heart, brain, lungs, and kidneys. This case highlights how fungal infections like cryptococcosis can affect people without HIV when their immune systems are compromised by other conditions or medications.

Background

Cryptococcosis is a fungal infection typically found in immunocompromised individuals, particularly those with HIV/AIDS. However, it can affect immunocompetent individuals and those with other forms of immunosuppression. This case describes a rare combination of disseminated cryptococcosis in an HIV-negative pregnant woman with myasthenia gravis treated with immunosuppressive medications.

Objective

To report an unusual case of disseminated cryptococcal infection in an HIV-negative pregnant woman with myasthenia gravis and to raise awareness of cryptococcal infection in immunosuppressed individuals without HIV/AIDS. The study aims to highlight the importance of maintaining high clinical suspicion for cryptococcosis in such cases.

Results

Autopsy revealed a 70 x 60 x 30mm mediastinal mass attached to the heart with disseminated cryptococcal infection involving multiple organs including the brain, lungs, kidneys, liver, pancreas, and bone marrow. Microscopic findings confirmed Cryptococcus yeasts with characteristic soap bubble appearance, measuring 4-10 μm with encapsulated narrow neck budding.

Conclusion

This case emphasizes the importance of maintaining high clinical suspicion for cryptococcal infection in immunosuppressed individuals without HIV/AIDS, including those with myasthenia gravis on immunosuppressive therapy and pregnant women. Serum cryptococcal antigen testing is the most straightforward method for early diagnosis and should not be overlooked even in unexpected cases.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Autopsy Case Report,
  • Source: PMID: 40893460; DOI: 10.1016/j.mmcr.2025.100726
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