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Low Antigen Titre Disseminated Cryptococcosis in Immunocompromised Hosts: Two Challenging Case Reports

Summary

Two patients with weakened immune systems developed serious fungal blood infections from Cryptococcus despite having unusually low levels of fungal markers in their blood. One was a kidney transplant patient and the other had HIV. Neither showed signs of brain infection, which is unusual for this disease. Both were successfully treated with aggressive antifungal medications once blood cultures confirmed the disseminated infection.

Background

Cryptococcosis is a systemic fungal infection caused by Cryptococcus that primarily affects immunocompromised patients. While CNS and pulmonary involvement are most common, disseminated disease can affect multiple organs. Bloodstream infections without CNS involvement are rare and underreported, presenting diagnostic challenges.

Objective

To present two unusual cases of disseminated cryptococcal infection with low serum antigen titres (1:80) and positive blood cultures without CNS involvement. The cases highlight the diagnostic challenges and clinical implications of atypical cryptococcal presentations in immunocompromised hosts.

Results

Case 1: Post-kidney transplant patient with pulmonary cryptococcosis (BAL positive, antigen 1:80) who developed disseminated infection confirmed by positive blood culture, requiring escalation to amphotericin-B and flucytosine. Case 2: HIV-positive patient with CD4 count of 9 cells/μL presenting with PJP and cryptococcal antigen 1:80 in serum with positive blood culture despite negative BAL and CSF, requiring high-dose amphotericin-B therapy.

Conclusion

These cases demonstrate rare presentations of disseminated cryptococcosis with low serum antigen titres and positive blood cultures without CNS involvement. Blood cultures are critical for diagnosis and determining appropriate antifungal therapy. Greater clinical vigilance and consideration of disseminated disease is warranted even with low antigen levels and absent meningeal symptoms.
  • Published in:American Journal of Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40515382, DOI: 10.12659/AJCR.946589
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