MYCOLab Ai Logo - gold and army green

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 died from a widespread fungal infection caused by Cryptococcus, which formed a large mass in her chest. Although she tested negative for HIV, her use of immunosuppressive medications to treat her muscle disease, combined with pregnancy’s natural effects on immune function, made her vulnerable to this serious fungal infection. The infection was initially misdiagnosed as tuberculosis, and the diagnosis was only confirmed after her death during autopsy, highlighting the importance of testing for fungal infections even in patients without HIV.

Background

Cryptococcosis is a fungal infection typically found in immunocompromised individuals, particularly those with HIV/AIDS. However, it can also affect immunocompetent or partially immunosuppressed individuals. This case presents a rare combination of disseminated cryptococcosis in a pregnant woman with myasthenia gravis (MG) who was HIV-negative.

Objective

To report an autopsy case of disseminated cryptococcosis presenting as mediastinal mass in an HIV-negative pregnant woman with myasthenia gravis and raise awareness of this rare combination for clinicians to maintain high index of suspicion in unsuspecting cases of immunosuppression.

Results

Autopsy revealed disseminated cryptococcal infection with mediastinal cryptococcoma (70 x 60 x 30mm mass) attached to the heart and multiple lesions in the hypophysis, brain stem, cerebellum, cerebral cortex, kidneys, lungs, bone marrow, and pancreas. Microscopic examination confirmed Cryptococcus species with characteristic soap bubble appearance and 4-10 μm encapsulated yeasts with narrow neck budding.

Conclusion

This case emphasizes the importance of maintaining high index of suspicion for cryptococcal infection in immunosuppressed patients without HIV/AIDS, including those on long-term corticosteroid therapy. Early diagnosis through serum cryptococcal antigen testing is critical, particularly in pregnant women where pregnancy may further compromise cell-mediated immunity.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Autopsy case report,
  • Source: PMID: 40893460
Scroll to Top