A Fatal Case of Misdiagnosed Cryptococcal Epididymo-Orchitis and Leg Cellulitis in a HIV-Negative Patient

Abstract

Patients with disorders of T-cell mediated immunity are at high risk for cryptococcal infection. We present a 61-year-old male who was receiving corticosteroid therapy for vasculitis-associated necrotizing glomerulonephritis. The patient presented with fever, right orchiepididymitis and cellulitis of both legs. Despite surgical and combined antibiotic treatment, he developed septic shock and multi-organ dysfunction. Histological examination of skin lesion revealed acute panniculitis and numerous fungi spores, while blood cultures revealed Cryptococcus neoformans. Further stains on the testis specimen confirmed also the presence of Cryptococcus. The patient received amphotericin B and his clinical condition and laboratory findings were improved. However, he developed septic shock due to multi-drug resistant Klebsiella pneumoniae nosocomial pneumonia and he finally died. Cryptococcal infection should be added to the differential diagnosis of epididymo-orchitis and cellulitis in immunocompromised hosts. Early diagnosis and therapy are essential if the case-fatality rates associated with disseminated infection are to be improved.




J Med Cases. 2013;4(3):179-181
doi: https://doi.org/10.4021/jmc1053e