Pediatric renal cryptococcosis: novel manifestations in the acquired immunodeficiency syndrome era.
Pediatric cryptococcosis has been documented in various organs, but pediatric renal cryptococcosis (RC) remains undocumented to date. The authors report RC in 2 children with AIDS, 7 and 9 years of age, with proteinuria. Both patients, on antiretroviral therapy (ARV) for 28 (patient 1) and 54 (patient 2) weeks each, had secured viral immunosuppression, but immune restoration was realized by patient 1 only. Cryptococcal immune reconstitution inflammatory syndrome (IRIS) was diagnosed on the renal biopsy from patient 1 based on the clinicopathological profile and the presence of segmental glomerular and an interstitial lymphoplasmacytic and granulomatous reaction to Cryptococcus neoformans, with a predominance of capsule-deficient fungal forms. The renal biopsy from patient 2 demonstrated typical HIV-associated nephropathy with focal intratubular and interstitial C neoformans yeasts. Pediatric AIDS-associated renal disease must be expanded to include RC and cryptococcal IRIS, and the kidney must be included as a potential sentinel site of IRIS.
Ramdial
Pratistadevi K
PK
Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal & National Health Laboratory Service, Durban, KwaZulu Natal, South Africa. ramdial@ukzn.ac.za
Sing
Yetish
Y
Deonarain
Julian
J
Bhimma
Rajendra
R
Chotey
Nivesh
N
Sewram
Vikash
V
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000382:microbiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D003455:Cryptococcus neoformans; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000382:microbiology*; D008297:Male; D011507:Proteinuria / Q000150:complications / Q000382:microbiology