Disseminated Cryptococcal Infection Causing Epididymo‐Orchitis and Masquerading as Lymphoma

1Coney Island Hospital, Brooklyn, NY
2Coney Island Hospital, Brooklyn, NY
3Coney Island Hospital, Brooklyn, NY

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 147

Case Presentation:

A 26‐year‐old man with a history of hypertension and end‐stage renal disease (ESRD) on hemodialysis for the past 8 months was sent to the hospital from the hemodialysis center for complaints of a fever of 102°F for 6 days with pain and swelling of the right supraclavicular fossa. Patient also had testicular pain and testicular sonogram revealed acute epididymo‐orchitis. Chest X‐ray revealed right lower lobe opacity. Blood cultures were drawn, and the patient was started empirically on broad‐spectrum antibiotics. A CT scan of the neck and chest revealed cervical lymphadenopathy, a large paratracheal mass with the flattening of the distal trachea on the right, infiltrates in the right middle and lower lobes, a small right‐sided pleural effusion, and a small pericardial effusion. Based on these findings the suspicion for lymphoma was high, and the patient underwent left supraclavicular lymph node biopsy. The patient was tested negative for HIV. The supraclavicular lymph node biopsy revealed acute inflammatory exudates and numerous fungal budding yeaste suggestive of cryptococci. Antibiotics were stopped, and the patient was started on fluconazole 200 mg after each dialysis. The patient's serum cryptococcal antigen assay was positive. Repeated blood cultures were negative. After S doses of treatment with fluconazole, his fever subsided with significant clinical improvement. A repeat CT scan of the chest after 3 weeks of starting fluconazole showed a decrease in the size of paratracheal mass and a decrease in the size of the lung infiltrates. The symptoms of epididymo‐orchitis also resolved.

Discussion:

Cryptococcus neoformans is an encapsulated yeast first described in 1984 by Busse and Buschke. The primary sites of infection are lung, CNS, and disseminated disease. In disseminated disease, the commonly involved organs are skin, prostate, and medullary cavities of bones. Less commonly it can cause myocarditis, chorioretinitis, hepatitis, peritonitis, and prostatitis. Cryptococci causing epididymo‐orchitis is extremely rare. In 1991, a case of isolated testicular cryptococcal orchitis complicating steroid therapy for relapsing polychondritis was reported. We present a unique case of disseminated cryptococcal infection causing epididymo‐orchitis in a HIV‐negative patient and masquerading as lymphoma.

Conclusions:

Hospitalists need to be aware of this unusual manifestation of cryptococcal infection and have a high degree of suspicion so as to initiate treatment early.

Author Disclosure:

A. Chandra, Maimonides Medical Center and Coney Island Hospital, employment; B. Roy, Coney Island Hospital, employment; R. Akhter, Coney Island Hospital, employment.

To cite this abstract:

Chandra A, Roy B, Akhter R. Disseminated Cryptococcal Infection Causing Epididymo‐Orchitis and Masquerading as Lymphoma. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 147. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/disseminated-cryptococcal-infection-causing-epididymoorchitis-and-masquerading-as-lymphoma/. Accessed May 26, 2019.

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