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Overwhelming cryptococcosis complicated by cryptococcal endocarditis
  1. Wiaam Elkhatib,
  2. Joshua Y Kwon and
  3. Michael B Phillips
  1. Internal Medicine, Mayo Clinic Hospital, Jacksonville, Florida, USA
  1. Correspondence to Dr Wiaam Elkhatib; wiaamelkhatib{at}


Cryptococcal species endocarditis is infrequently described, carries high mortality and nearly always occurs in immunocompromised states or on prosthetic valves. We report the case of a man in his 70s with multiple recent hospitalisations for pneumonia, hypercalcaemia and septic tank exposure who presented with intermittent fevers, progressive weakness,and worsening encephalopathy, manifested as confusion and word-finding difficulties for 3 weeks. Workup revealed cryptococcal species on blood serum gram stain, native aortic valve endocarditis and meningitis. Cerebrospinal fluid analysis demonstrated lymphocytosis, ultimately found to be secondary to chronic lymphocytic leukaemia. Surgical valve replacement was deemed medically contraindicated and antifungal therapy was initiated. Though poorly understood with very few documented cases, management of cryptococcal endocarditis relies on prompt diagnosis, early surgery when indicated, long-term antifungal therapy and treatment of underlying immunocompromising states where possible.

  • valvar diseases
  • chronic myeloid leukemia
  • cryptococcosis
  • cryptococcus
  • infections

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  • Contributors WE: study concept and design, drafting of the manuscript and critical revision of the manuscript for important intellectual content. JYK: study concept and design and critical revision of the manuscript for important intellectual content. MBP: study concept and design, critical revision of the manuscript for important intellectual content and study oversight.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.