Mixed infection by Cryptococcus neoformans and Cryptococcus gattii and coinfection with paracoccidioidomycosis in PLHIV

We present a rare condition of mixed C. neoformans and C. gattii infection in a person living with HIV with false-negative CrAg LFA in the CSF and co-infection with paracoccidioidomycosis. Signs and symptoms are relative to respiratory tract and skin, confounding with other opportunistic disease. After negatives CrAg LFA and Indian ink staining in CSF, there was isolation of C. gattii in sputum and C. neoformans in CSF, in addition to reagent serology (double immunodiffusion) for PCM with 1/16 titer. The patient was treated with amphotericin B and TMP-SMX with good clinical response and recovery of cellular immunity after initiation of antiretroviral therapy.

Automated summary

We report a rare case of mixed infection with C. neoformans and C. gattii in an HIV patient, along with co-infection with paracoccidioidomycosis. The symptoms are related to the respiratory tract and skin, which can be confused with other opportunistic diseases. After negative results for CrAg LFA and Indian ink staining in the cerebrospinal fluid (CSF), C. gattii was isolated from sputum and C. neoformans from CSF. The patient was treated with amphotericin B and TMP-SMX, resulting in a good clinical response and recovery of cellular immunity after antiretroviral therapy initiation.