title: Disseminated cryptococcosis with caverno-oesophageal fistula in a case of idiopathic CD4+ T-lymphocytopenia.
abstract: Idiopathic CD4+ T-Lymphocytopenia is a rare immunodeficiency disorder characterised by significantly low absolute CD4 lymphocytes in absence of any viral infections. We present a case of Disseminated Cryptococcosis with Caverno- Oesophageal Fistula in a case of Idiopathic CD4+ T-Lymphocytopenia. 29 year old lady was referred to Institute in view of lung mass not responding to anti-TB treatment. Subsequently patient had developed headache. Radiological evaluation showed presence of ring enhancing lesion in the occipital region. On evaluation with Fibre-optic bronchoscopy, there was no evidence of malignancy or tuberculosis. Sputum showed presence and growth of Cryptococcus neoformans. Patient's investigations were negative for virus infection, with normal immunoglobulin levels. Her CD4 counts were 129 cells/mm3. Patient was treated with injectable antifungals. Patient developed a Caverno-oesophageal fistula which was confirmed on endoscopy and radiology. Patient was managed with percutaneous jejunal feeding (PEJ). Patient improved symptomatically with CD4 count of 475 cells/mm3.
authors.forename: Jairaj P
authors.initials: JP
authors.lastname: Nair
authors.forename: Amita U
authors.initials: AU
authors.lastname: Athavale
authors.forename: Sonal
authors.initials: S
authors.lastname: Gawande
authors.forename: Unmil
authors.initials: U
authors.lastname: Shah
authors.forename: Milind
authors.initials: M
authors.lastname: Baldi
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupt
authors.forename: Varun
authors.initials: V
authors.lastname: Gavali
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage; D003453:Cryptococcosis / Q000150:complications* / Q000453:epidemiology*; D003455:Cryptococcus neoformans; D004937:Esophageal Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D009778:Occipital Lobe / Q000382:microbiology; D011859:Radiography; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D013183:Sputum / Q000382:microbiology; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole