J Pediatr Infect Dis 2014; 09(02): 101-107
DOI: 10.3233/JPI-140416
Case Report
Georg Thieme Verlag KG Stuttgart – New York

Fatal cryptococcosis presenting as hepatobiliary dysfunction in an ALL patient

Brandon R. McNew
a  Department of Pediatrics, Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
,
Ayman El-Sheikh
a  Department of Pediatrics, Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
,
Patricia A. Kirby
b  Department of Pathology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
,
Warren P. Bishop
c  Department of Pediatrics, Division of Pediatric Gastroenterology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
,
Ghada A. Abusin
a  Department of Pediatrics, Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
› Author Affiliations

Subject Editor:
Further Information

Publication History

11 February 2014

11 April 2014

Publication Date:
28 July 2015 (online)

Abstract

Although current therapies for acute lymphoblastic leukemia (ALL) in children provide high cure rates, invasive fungal infections remain a significant source of mortality. We report a fatal case of cryptococcosis presenting as hepatic dysfunction in a patient with ALL and Down syndrome. Autopsy results confirmed Cryptococcus septicemia with involvement of lungs, liver, and lymph nodes. The severity of the fungal sepsis and underlying immunosuppression probably contributed to the unusual presentation and fatal outcome. This report highlights the need to consider cryptococcal infection as a cause of sepsis syndrome in immunocompromised patients when bacterial cultures are negative.