![]() After 5 days, bone marrow aspirate culture yielded encapsulated yeasts in budding on India ink stain, identified as Cryptococcus sp. The direct examination presented a non-specific hypocellularity and was negative for fungi, mycobacteria and hemoparasites. India ink staining showed capsulated budding yeast cells. Due to pancytopenia, the patient underwent a bone marrow aspirate and biopsy. BAL cytology by Papanicolaou smear showed unstained round structures with occasional budding, suspicious for Cryptococcus which was confirmed with special stain for fungus Gomori methenamine silver. Cutaneous manifestations are seen in disseminated disease. BAL mycobacterial culture and Xpert MTB/RIF Ultra assay were negative. 1 Altmetric Metrics Abstract Cryptococcuria is a rare manifestation of localized cryptococcal disease. India ink staining shows the organisms directly with an approximate sensitivity of 70%, whereas CSF cryptococcal latex antigen testing has a sensitivity approaching 90%. Opening pressures may be quite elevated on LP, and CSF values usually reveal a normal CSF glucose concentration, a mildly elevated CSF protein concentration, and a CSF leukocyte count of less than 20/mL. Diagnosis is usually made on examination of cerebrospinal fluid (CSF). Seizures or focal neurologic presentations are rare, and neck stiffness and/or photophobia are usually absent. Symptoms may be present for several weeks, and diagnostic delay is common. The onset tends to be insidious with fairly nonspecific symptoms such as fever, nausea, and headache. Cryptococcal meningoencephalitis typically manifests itself in patients whose CD4 cell counts are less than 50/mm 3. Cryptococcus neoformans is the most common cause of meningitis in patients with HIV/AIDS. BM examination revealed no signs of dysmegakaryopoiesis or plasma cell invasion, but there were several histiocytes with intracellular encapsulated bodies identified as fungal cells.
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