An Unusual Presentation of Disseminated Cryptococcosis in a Middle AgedFemale

Cryptococcosis is a common opportunistic pathogen in the setting of advanced human immunodeficiency virus (HIV) infection especially with CD4 count less than 50 cells/micro liter and in other immunodeficient conditions such as hematologic malignancies, transplant recipients or in persons on prolonged glucocorticoid and/or immunosuppressant therapy. Disseminated cryptococcosis is uncommon in immunocompetent person. We detected such a case at our institute presented initially with pulmonary mass lesion and later evolving into chronic non-healing skin ulcer and asymptomatic brain involvement without having any evidence of overt immunosuppression. However the patient developed gall-bladder carcinoma about one and half years after her chest complaints. She underwent surgical resection but neither received radiotherapy nor chemotherapy post-surgery. She was treated successfully with anti-fungal combination therapy as per Infectious Diseases Society of America (IDSA) guideline.