title: FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT.
abstract: BACKGROUND
  We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room.
  
  
  METHODS
  The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm³ (5% lymphocytes), hemoglobin was 10 g/dL, platelets were 83,000/ mm³. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm³ (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm³. India ink test revealed six Cryptococcus yeasts/mm³. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys.
  
  
  CONCLUSIONS
  Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.
authors.affiliation: Hospital Universitário Walter Cantídio, Federal University of Ceara, Fortaleza, CE, BR.
authors.forename: Elizabeth De Francesco
authors.initials: Ede F
authors.lastname: Daher
authors.affiliation: Hospital Universitário Walter Cantídio, Federal University of Ceara, Fortaleza, CE, BR.
authors.forename: Jarinne Camilo Landim
authors.initials: JC
authors.lastname: Nasserala
authors.affiliation: School of Medicine, University of Fortaleza, Fortaleza, CE, BR.
authors.forename: Geraldo Bezerra da
authors.initials: GB
authors.lastname: Silva Junior
authors.affiliation: Department of Pathology, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, BR.
authors.forename: Adriana Regina Vilarinho de
authors.initials: AR
authors.lastname: Oliveira
authors.affiliation: Department of Pathology, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, BR.
authors.forename: José Urbano de
authors.initials: JU
authors.lastname: Medeiros Neto
authors.affiliation: Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, BR.
authors.forename: Anastácio Queiroz
authors.initials: AQ
authors.lastname: Sousa
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000473:pathology; D000328:Adult; D003453:Cryptococcosis / Q000150:complications* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D007674:Kidney Diseases / Q000382:microbiology* / Q000473:pathology; D008297:Male