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Progressive Cytopenia Developing during Treatment of Cryptococcosis in a Patient with HIV Infection and Bone Marrow Cryptococcal Infection
Authors:Mai Katsura  Ayako Okuhama  Yoshiki Koizumi  Naokatsu Ando  Yasuaki Yanagawa  Daisuke Mizushima  Takahiro Aoki  Kunihisa Tsukada  Katsuji Teruya  Yoshimi Kikuchi  Shinichi Oka  Koji Watanabe
Institution:1.AIDS Clinical Center of the National Center for Global Health and Medicine, Japan
Abstract:Cytopenia is a common complication in patients with human immunodeficiency virus (HIV) infection. Identifying the cause is demanding because of the wide range of possible diagnoses. We herein report an HIV-infected patient with disseminated cryptococcosis involving multiple organs including the blood, brain, lungs, and bone marrow, who developed progressive pancytopenia after initiation of anti-fungal treatment with liposomal amphotericin-B (L-AMB) and flucytosine (5FC). The pancytopenia persisted despite early 5FC discontinuation. A bone marrow biopsy revealed cryptococcal infiltration and the blood examination findings recovered quickly after resuming L-AMB. Thus, this HIV-infected patient''s pathological findings and clinical course suggested that the primary cause of the pancytopenia was bone marrow cryptococcosis.
Keywords:Cryptococcus  HIV  cytopenia  adrenal insufficiency
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