P1019 - Case of Disseminated Cryptococcal Gastritis in an AIDS Patient

Luis A. Gil, DO¹, Andrew Dam, DO¹, Micaella Kantor, MD¹, Sarah Arvaneh, DO¹, Luis Nasiff, MD, FACG^2
1Larkin Community Hospital, Hialeah, FL; ²Larkin Community Hospital, Miami, FL

Introduction: Cryptococcus neoformans is an encapsulated yeast often seen as an opportunistic infection in immunocompromised patients. Case reports reviewed showed Cryptococcal gastritis as an additional finding of Cryptococcosis. To the best of our knowledge, only a few cases of Cryptococcal gastritis have been reported as a presenting feature of Cryptococcosis. We describe a case of Cryptococcal gastritis in a patient with newly diagnosed AIDS.

Case Description/Methods: A 56 year old male with past medical history of GERD presented to the ED with symptoms of nausea, vomiting, and a 30 lb unintentional weight loss over a 5 month duration. Physical exam revealed a frail, cachectic male with epigastric tenderness. WBC was 3.3, CD4 count was 13/µL, HIV screening was positive. Blood cultures positive x2 for cryptococcus neoformans. EGD showed mild gastritis at the antrum of stomach and duodenitis. Biopsies were positive for PAS, GMS, Alcian blue stain, and monoclonal CD 163 antibodies, suggestive of Cryptococcus neoformans. The patient was treated with Amphotericin B, Antiretrovirals and empiric antibiotics.

Discussion: In patients with HIV/Acquired Immunodeficiency Syndrome, Cryptococcus neoformans infections are frequent. The majority of patients initially have neurologic involvement (meningitis), and less frequently respiratory symptoms.1 Of the few cases that have been individually reported, gastrointestinal symptoms occur secondarily in patients with other manifestations such as meningitis or Diabetes Mellitus.2,3 Symptomatic gastroduodenitis as the initial presentation of disseminated Cryptococcosis is uncommon. This case suggests upper gastrointestinal symptoms in HIV/acquired immunodeficiency syndrome patients may be the initial presentation of disseminated Cryptococcosis. Upper gastrointestinal endoscopy with biopsy is an excellent way to diagnose Cryptococcal gastritis.



References:

1. 
   Gazzoni A.F., Severo C.B., Barra M.B., et al. Atypical micromorphology and uncommon location of cryptococcosis: a histopathologic study using special histochemical techniques (one case report). Mycopathologia. 2009; 167: 197-202
   
   

2. 
   Hajjeh R.A., Conn L.A., Stephens D.S., et al. Cryptococcosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. J Infect Dis. 1999; 179: 449-454
   
   

3. 
   Yagi, T., Fukuda, K., Isogai, S., et al. (1975). A Case of Diabetes Mellitus Associated with Cryptococcus Infection. Journal of the Japan Diabetes Society, 18(2), 174–180.
   
   

Figure: Histological Slide of Cryptococcus neoformans


Disclosures:
Luis Gil indicated no relevant financial relationships.
Andrew Dam indicated no relevant financial relationships.
Micaella Kantor indicated no relevant financial relationships.
Sarah Arvaneh indicated no relevant financial relationships.
Luis Nasiff indicated no relevant financial relationships.


Luis A. Gil, DO¹, Andrew Dam, DO¹, Micaella Kantor, MD¹, Sarah Arvaneh, DO¹, Luis Nasiff, MD, FACG². P1019 - Case of Disseminated Cryptococcal Gastritis in an AIDS Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.