March 2014, Vol 145, No.

3_MeetingAbstracts

Chest Infections | March 2014

Cryptococcal Pneumonia and Disseminated

Histoplasmosis Coinfection in Newly
Diagnosed HIV Patient
Parth Rali, MD; Hardik Soni, MD; Win Naing, MD; Viral Gandhi, MD
Allegheny General Hospitali, Pittsburgh, PA

Chest. 2014;145(3_MeetingAbstracts):102A. doi:10.1378/chest.1822027

Abstract
SESSION TITLE: Infectious Disease Case Reports Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Case report

CASE PRESENTATION: 27 y/o M originally from Ecuador , recently diagnosed with HIV
presented with 3 weeks of shortness of breath, fever, hemoptpysis, pleuritic chest pain associated
with 10 lb weight loss & night sweats. On presentation Chest X ray showed left lower lobe
infiltrates and left mid chest cavitary lesion with air fluid level. The finding were confirmed on
CT scan of chest. Serum Cryptococcal Antigen test came positive with titer of 1:256, with
negative CSF cryptococcal antigen. Patient was started on broad spectrum antibiotics,
Amphotericin, Bactrim and prednsione. Fungal smear from BAL showed Cryptococcus. CT
abdomen showed significant hepatosplenomegaly and mesenteric lymphadenopathy. Urine
histoplasma antigen was positive with titer of 1:19. All other work up for PCP and other
opportunistic infection was negative. Patient continued to improve on Amphotericin B, later on
switched to Itraconazole, and discharged home with itraconazole and Infection Disease clinic
follow up

DISCUSSION: 27 y/o M originally from Ecuador , recently diagnosed with HIV presented with
3 weeks of shortness of breath, fever, hemoptpysis, pleuritic chest pain associated with 10 lb
weight loss & night sweats. On presentation Chest X ray showed left lower lobe infiltrates and
left mid chest cavitary lesion with air fluid level. The finding were confirmed on CT scan of
chest. Serum Cryptococcal Antigen test came positive with titer of 1:256, with negative CSF
cryptococcal antigen. Patient was started on broad spectrum antibiotics, Amphotericin, Bactrim
and prednsione. Fungal smear from BAL showed Cryptococcus. CT abdomen showed significant
hepatosplenomegaly and mesenteric lymphadenopathy. Urine histoplasma antigen was positive
with titer of 1:19. All other work up for PCP and other opportunistic infection was negative.
Patient continued to improve on Amphotericin B, later on switched to Itraconazole, and
discharged home with itraconazole and Infection Disease clinic follow up.

CONCLUSIONS: This case highlights the fact that HIV patients with low CD4 count are at risk
of dual opportunistic infection with histoplasmosis and cryptococcus pneumonia.

Reference #1: Clin Infect Dis. (2000) 30 (4): 710-718. doi: 10.1086/313757

DISCLOSURE: The following authors have nothing to disclose: Parth Rali, Hardik Soni, Win
Naing, Viral Gandhi

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