Disseminated cryptococcosis and hepatitis C virus infection: A fatal co-infection

Document Type : Case report


Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India


Background and Purpose: We report a case of disseminated cryptococcosis in a treatment-naïve patient, incidentally diagnosed with hepatitis C virus (HCV) infection and renal parenchymal disease. The patient succumbed to death given the very late diagnosis of the disease.
Case report: A 54-year-old male presented with the chief complaints of abdominal pain, chest pain, and phlegmy cough for a month. There was a past history of decreased urine output, lower limb swelling, and fever lasting for 15-20 days. After a general physical examination, the differential diagnosis of hepatitis C-related liver disease with hepatic encephalopathy, disseminated tuberculosis, and septic shock was made. Radiological examination revealed renal parenchymal disease on ultrasound abdomen and opacity with reticulonodular opacity in the bilateral lung zones. In laboratory investigations, serum reactive sample was tested for anti-HCV antibodies. In addition, Cryptococcus var grubii was identified in blood culture using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient succumbed to death before the initiation of any specific antifungal therapy.
Conclusion: Cryptococcosis-HCV co-infection is a fatal condition with a fulminant course that might be difficult to treat.


1. Pappas PG. Cryptococcal infections in non-HIV-infected patients. Trans Am Clin Climatol Assoc. 2013; 124:61-79.
2. Kwon-Chung KJ, Varma A. Do major species concepts support one, two or more species within Cryptococcus neoformans? FEMS Yeast Res. 2006; 6(4):574-87.
3. Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin N Am. 2016; 30(1):179-206.
4. Spies FS, de Oliveira MB, Krug MS, Severo CB, Severo LC, Vainstein MH. Cryptococcosis in patients living with
hepatitis C and B viruses. Mycopathologia. 2015; 179(3-4):307-12.
5. Suchitha S, Sheeladevi CS, Sunila R, Manjunath GV. Disseminated cryptococcosis in an immunocompetent patient: a case report. Case Rep Pathol. 2012; 2012:652351.
6. Subramanian S, Mathai D. Clinical manifestations and management of cryptococcal infection. J Postgrad Med. 2005; 51(Suppl 1):S21-6.
7. El-Serag HB, Anand B, Richardson P, Rabeneck L. Association between hepatitis C infection and other infectious diseases: a case for targeted screening? Am J Gastroenterol. 2003; 98(1):167-74.
8. Gupta KL. Fungal infections and the kidney. Indian J Nephrol. 2001; 11(4):147-54.
9. National viral hepatitis control program (NVHCP). Ministry of Health and Family Welfare (MoHFW), Government of India. Available at: URL: https:// www.nhp.gov.in/national-viral-hepatitis-control-program- (nvhcp)_pg; 2018.
10. Aye C, Henderson A, Yu H, Norton R. Cryptococcosis-the impact of delay to diagnosis. Clin Microbiol Infect. 2016; 22(7):632-5.
11. Bratton EW, El Husseini N, Chastain CA, Lee MS, Poole C, Stürmer 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.
Volume 5, Issue 4
December 2019
Pages 50-53
  • Receive Date: 26 June 2019
  • Revise Date: 15 October 2019
  • Accept Date: 08 December 2019
  • First Publish Date: 08 December 2019
  • Publish Date: 01 December 2019