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Lymphadenitis and meningoencephalitis resulting from Cryptococcus neoformans infection in HIV patients

  • Stephanie Sugiharto ,
  • I Made Susila Utama ,
  • Luh Putu Iin Indrayani Maker ,


Background: Lymphadenopathy can occur at any stage of HIV infection, with multiple aetiologies including reactive, infectious and malignant. An accurate and timely diagnosis has obvious implications for treatment.

Case Description: We report cryptococcal lymphadenitis as the presenting manifestation of HIV infection. Clinical symptoms observed in the patient included headaches, fever, non-productive cough, nausea, vomiting, white patches on the tongue, nodules in the right and left jaw area, a weight loss of 10 kilograms within a month, and a decrease in consciousness in the middle of treatment. The diagnosis was eventually confirmed with a lymph node fine needle aspiration biopsy. Fine needle aspiration biopsy (FNAB) indicated chronic granulomatous inflammation with a fungal (yeast) infection, suggestive of Cryptococcus.

Conclusion: Cryptococcosis is a major invasive fungal infection capable of causing widespread disease outbreaks in immunocompromised hosts, and even in seemingly immunocompetent individuals. Cryptococcal infection should be a diagnostic consideration for lymphadenopathy in every patient, regardless of known HIV infection.


  1. Dogbey P, Golden M, Ngo N. Cryptococcal lymphadenitis: an unusual initial presentation of HIV infection. BMJ Case Rep. 2013;2013:bcr2013010316.
  2. Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017;17(8):873-81.
  3. Pyrgos V, Seitz AE, Steiner CA, Prevots DR, Williamson PR. Epidemiology of Cryptococcal Meningitis in the US: 1997-2009. PLoS One. 2013;8(2):e56269.
  4. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(3):291-322.
  5. Dromer F, Mathoulin-Pelissier S, Launay O, Lortholary O; French Cryptococcosis Study Group. Determinants of disease presentation and outcome during cryptococcosis: the CryptoA/D study. PLoS Med. 2007;4:e21.
  6. Justiz Vaillant AA, Naik R. HIV-1 Associated Opportunistic Infections. [Updated 2022 Sep 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  7. Anglaret X, Minga A, Gabillard D, Ouassa T, Messou E, Morris B, et al. AIDS and non-AIDS morbidity and mortality across the spectrum of CD4 cell counts in HIV-infected adults before starting antiretroviral therapy in Cote d'Ivoire. Clin Infect Dis. 2012;54(5):714-23.
  8. Abid MB, De Mel S, Limei MP. Disseminated Cryptococcal infection in an immunocompetent host mimicking plasma cell disorder: a case report and literature review. Clin Case Rep. 2015;3(5):319-24.
  9. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children. Available from:
  10. Berhane Y, Haile D, Tolessa T. Anemia in HIV/AIDS patients on antiretroviral treatment at Ayder Specialized Hospital, Mekele, Ethiopia: A case-control study. J Blood Med. 2020;11:379-87.
  11. Nasit JG, Dhruva G. Cryptococcal lymphadenitis in a human immunodeficiency virus-infected patient: A diagnostic role of fine needle aspiration cytology and special stains. Indian J Sex Transm Dis AIDS. 2016;37(2):205-6.
  12. Pyrgos V, Seitz AE, Steiner CA, Prevots DR, Williamson PR. Epidemiology of Cryptococcal Meningitis in the US: 1997-2009. PLoS One. 2013;8(2):e56269.
  13. Bratton EW, El Husseini N, Chastain CA, Lee MS, Poole C, Sturmer T, et al. Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant. PloS one. 2012;7(8):e43582.
  14. Bicanic T, Brouwer AE, Meintjes G, Rebe K, Limmathurotsakul D, Chierakul W, et al. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. AIDS. 2009;23(6):701-6.
  15. Idnurm A, Bahn YS, Nielsen K, Lin X, Fraser JA, Heitman J. Deciphering the model pathogenic fungus Cryptococcus neoformans. Nat Rev Microbiol. 2005;3(10):753-64.
  16. Alvarez M, Casadevall A. Phagosome extrusion and host-cell survival after Cryptococcus neoformans phagocytosis by macrophages. Curr Biol. 2006;16(21):2161-5.
  17. Li SS, Mody CH. Cryptococcus. Proc Am Thorac Soc. 2010 May;7(3):186-96.

How to Cite

Sugiharto, S., Utama, I. M. S., & Maker, L. P. I. I. (2024). Lymphadenitis and meningoencephalitis resulting from Cryptococcus neoformans infection in HIV patients. Intisari Sains Medis, 15(1), 49–54.




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Stephanie Sugiharto
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I Made Susila Utama
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Luh Putu Iin Indrayani Maker
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