Concurrent Cryptococcal Meningitis, Disseminated Histoplasmosis, and Tuberculosis Lymphadenitis in a Newly Diagnosed Human Immunodeficiency Virus Patient: An Unusual Case Report

ABSTRACT

A 45-year-old male with a recent diagnosis of Human Immunodeficiency Virus (HIV) infection, initiated on antiretroviral therapy one month earlier, presented with a 15-day history of persistent headache, accompanied by vomiting for three days, cough, and significant weight loss over the past month. Physical examination revealed palpable left cervical lymphadenopathy. The patient had previously been hospitalized at another center, where he received treatment; however, evaluation for histoplasmosis had not been performed at that time. Fine-Needle Aspiration Cytology (FNAC) of the cervical lymph node demonstrated granulomatous lymphadenitis with the presence of Histoplasma species, confirming disseminated histoplasmosis. Due to persistent neurological symptoms, Cerebrospinal Fluid (CSF) examination was performed. India ink staining revealed numerous Cryptococcus organisms, while CSF parameters showed a glucose level of 28 mg/dL and protein level of 174 mg/dL, findings consistent with cryptococcal meningitis. The patient was started on amphotericin B and fluconazole, along with Antitubercular Therapy (ATT), levetiracetam for seizure prophylaxis, and supportive care. During treatment, amphotericin B-associated nephrotoxicity developed, with serum creatinine rising to 1.45 mg/dL. Consequently, amphotericin B was discontinued, and antifungal therapy was modified to flucytosine while continuing fluconazole and ATT. Following adjustment of the treatment regimen and supportive management, the patient showed gradual clinical improvement. This case describes a rare coexistence of cryptococcal meningitis, disseminated histoplasmosis, and tuberculous lymphadenitis in a newly diagnosed HIV patient. The report highlights the importance of early screening for multiple opportunistic infections, thorough diagnostic evaluation, and careful management of drug toxicities to improve outcomes in immunocompromised individuals.

KEYWORDS

• Cryptococcal meningitis
• Histoplasmosis
• HIV
• Opportunistic infections
• Tuberculosis

Showing references and in-text citations exactly as published.

• DOI10.5530/jppcm.20260004Copy

RELATED ARTICLES

Matched on section and article type within this issue of JPPCM.

• Article · VOLUME 12, ISSUE 3A Case Report on Decompensated Chronic Liver Disease with Budd–Chiari SyndromeMallela Maharshi, Joel Nathan Thaneti, Padigala Ramya Jyothi, A. G. N. Harshita Devi, Nani Deepa, Ganjala Hemalatha, Jonnadula Kedareswari, Nemalikanti Elizabeth Mary Paul, Manchikanti Hima Sathwika, Vijaya Bhaskar Jirra · pp. 176–179Case ReportSame type: Article
• Article · VOLUME 12, ISSUE 3Exogenous Cushing’s Syndrome with Steroid-Induced Adrenal Insufficiency Complicated by Sepsis and a Non-healing Diabetic Foot Ulcer: A Case ReportHardik Prajapat, Meharunisha Siddiqui, Daizy Tak, Narendra Bheemraj Parihar, Jishi Joshi Joseph, Mahendra Singh Rathore · pp. 180–183Case ReportSame type: Article
• Article · VOLUME 12, ISSUE 3A Case Report on Cervical Canal Stenosis Secondary to Ossification of Posterior Longitudinal LigamentKorikani Lavanya, Galanki Arundathi Kavya, Shaik Muskan, Kriti Suberi Chettri, Chinta Nageswara Rao · pp. 188–190Case ReportSame type: Article
• Article · VOLUME 12, ISSUE 3A Case Reports On Bilateral Diffuse Cystic Lung Disease (Pulmonary Langerhans’ Cell Histiocytosis)Faizan Ali Shaik, Snehitha Kasu, Kedareswari Jonnadula, Hemalatha Ganjala, Hima Sathwika Manchikanti, Sandhya Kota, Ramya Valaparla · pp. 191–195Case ReportSame type: Article