Mycobacterium avium complex and Cryptococcus neoformans co-infection in a patient with acquired immunodeficiency syndrome: a case report

ABSTRACT

Introduction

Opportunistic infections (OI) are common in patients with acquired immunodeficiency syndrome (AIDS). Cryptococcus neoformans and Mycobacterium avium complex (MAC) are frequently responsible of such infections. However, concurrent infection with these two pathogens is uncommon and underreported in the literature.

Case description

We describe the case of a 28-year-old Caucasian Belgian patient with no travel history, who presented with low-grade fever, headache and wasting syndrome. He was diagnosed with human immunodeficiency virus (HIV) infection at AIDS stage, with a HIV viral load of 506,000 viral copies/mL and a CD4 + T-cells count of 10 cells/µL. Diagnosis of disseminated Cryptococcus neoformans infection was made by positive serum cryptococcal antigen and positive culture for Cryptococcus neoformans in blood and in cerebrospinal fluid. Diagnosis of disseminated Mycobacterium avium complex infection was made by positive culture on a biopsy of a mediastinal lymph node. With adequate anti-retroviral therapy (ART) and treatment of these OIs, the patient recovered well and had a good clinical evolution.

Discussion and conclusion

To our knowledge, this is the second case of coexistence of these two dangerous OIs reported in the post ART era. Clinicians should be aware that such co-infections still happen in high-income countries, in patients with severe immunodeficiency. Early detection and treatment of HIV is of paramount importance to prevent AIDS and its complications. We highlight the importance of thoroughly excluding all opportunistic infections in patients with newly diagnosed AIDS.

Abbreviations: ABC: abacavir; AIDS: acquired immunodeficiency syndrome; AFB: acid-fast bacilli; ART: antiretroviral therapy; CM: cryptococcal meningitis; CrAg: cryptococcal antigen; CSF: cerebrospinal fluid; CT: computed tomography; EACS: European AIDS Clinical Society; FTC: emtricitabine; HIC: high-income countries; HIV: human immunodeficiency virus; HIV-VL: HIV-viral load; ICP: intracranial pressure; IRIS: immune reconstitution inflammatory syndrome; MAC: Mycobacterium avium complex; MRI: magnetic resonance imaging; MSM: man who has sex with men; NR: normal range; OD: omne in die = once daily; OI: opportunistic infection; RAL: raltegravir; TAF: tenofovir alafenamide fumarate

KEYWORDS:

• HIV
• AIDS
• Cryptococcus neoformans
• Mycobacterium avium complex
• opportunistic infections

Acknowledgments

Severine Evrard, microbiologist at the Centre Hospitalier Regional de Liege (4000 Liege, Belgium), for providing the patient’s CSF India Ink Cryptococcus pictures.

Florence Ledure, MD, radiologist at the Centre Hospitalier Regional de Liege (4000 Liege, Belgium), for providing the patient’s MRI pictures.

Laura Rinchey, MD, GP working for Doctors Without Borders, for medical English proofreading of the manuscript.

Authors’ contributions

EG, BP, FM took active part in managing the patient during the hospitalisation. BP follows-up the patient since the hospitalisation, as the referent infectious disease specialist.

EG wrote the manuscript. BP, FM, AA, LG, EF, MM, and GD reviewed the manuscript.

All authors approved the final manuscript.

Consent for publication

Written informed consent for publication of his clinical details and clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal.

Disclosure statement

The authors declare no competing interest.

Geographical information

Liege (4000), BELGIUM

Additional information

Funding

There is no funding to report for this manuscript.