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An Unusual Case of Gastric Cryptococcosis Presenting as Ulcerations in an AIDS Patient

97

Borum, Marie L., M.D., Ed.D., M.P.H.; Ali, M. Aamir, M.D.; Cirino, Christopher, D.O.; Parenti, David, M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S55
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: STOMACH
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Division of Gastroenterology, Dept of Medicine, George Washington University, Washington, DC and Division of Infectious Diseases, Department of Medicine, George Washington University, Washington, DC.

Purpose: Cryptococcus neoformans is the most common systemic mycosis in AIDS. While this organism is known to cause disseminated disease, gastric involvement has rarely been reported. There presently are only 4 published cases of gastric cryptococcosis. We report the first case of gastric cryptococcosis presenting as ulcerations in an AIDS patient.

Case: The patient is a 36 year old man with a history of AIDS (CD4 count 34) who was referred for evaluation of a 2 week history of progressive nausea, vomiting and an inability ot maintain oral intake. He also reported several days of odynophagia and diarrhea. Past medical history was significant for a diagnosis of HIV one year prior to admission following a 40 pound unintentional weight loss. He had no prior opportunistic infections. The patient's medications included antiretroviral therapy and prophylactic Bactrim and Zithromax. The examination was significant for a temperature of 38.8°C, scant oral thrush, mild abdominal distention and guaiac negative stool.

While hospitalized the patient developed right arm and leg paresthesias and weakness. Blood cultures, stool cultures and a lumbar puncture were performed. A head CT was negative. An abdominal CT revealed colonic dilatation. An EGD demonstrated diffuse esophageal and gastric erythema with multiple, irregular nonbleeding ulcerations. Biopsies demonstrated Cryptococcus neoformans. Blood, stool and CSF cultures were also positive for Cryptococcus neoformans. The patient was treated with intravenous amphotericin B with rapid resolution of the gastrointestinal and neurologic symptoms.

Conclusion: Cryptococcal infections most commonly cause pulmonary or CNS disease. In severely immunocompromised patients, Cryptococcus neoformans can become disseminated. However, gastric involvement has rarely been reported antemortem and the endoscopic description has been variable. This is the first case of gastric cryptococcosis presenting as ulcerations. It is important to recognize this gastric manifestation of cryptococcosis in effort to increase our understanding of the disease and enhance our management of infected patients.

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