title: Profound muscle weakness as the presenting feature of disseminated cryptococcal infection.
abstract: A patient with chronic lymphocytic leukemia who was treated with immunosuppressive therapy for a prolonged period presented with profound muscle weakness secondary to disseminated cryptococcosis. The infection developed despite 3 months of continuous ketoconazole therapy and was not responsive to amphotericin B or flucytosine. At autopsy, Cryptococcus neoformans was present in all sampled skeletal muscles, myocardium, and muscularis propria of the gastrointestinal tract but was not identified in either the central nervous system or the lungs. A review of the English-language literature failed to identify a similar case with such profound myotropism due to Cryptococcus. This case demonstrates that cryptococcosis should be considered in the differential diagnosis of an immunocompromised host presenting with muscle weakness.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis.
authors.forename: D D
authors.initials: DD
authors.lastname: Hurd
authors.forename: D B
authors.initials: DB
authors.lastname: Staub
authors.forename: R I
authors.initials: RI
authors.lastname: Roelofs
authors.forename: L P
authors.initials: LP
authors.lastname: Dehner
mesh_terms: D003453:Cryptococcosis / Q000209:etiology / Q000503:physiopathology*; D003455:Cryptococcus neoformans; D004576:Electromyography; D005260:Female; D006321:Heart / Q000382:microbiology; D006801:Humans; D007108:Immune Tolerance; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D009132:Muscles / Q000382:microbiology / Q000503:physiopathology*; D009135:Muscular Diseases / Q000209:etiology / Q000503:physiopathology*