Cutaneous manifestations are seen in disseminated disease. Donut-shaped yeasts on India ink were seen (Fig.1c). Glucose is frequently low, and encapsulated yeasts forming narrow-based buds can be seen on India ink smears in most patients, especially in those who have AIDS. India ink staining shows the organisms directly with an approximate sensitivity of 70%, whereas CSF cryptococcal latex antigen testing has a sensitivity approaching 90%. Gram staining, CSF culture, wet prep, and India ink were performed.
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. In this study, we report 2 cases of disseminated cryptococcosis due to Cryptococcus neoformans with central nervous system (CNS) involvement but no inflammation in patients with chronic lymphoid malignancies at our center, both occurring within 1 month of starting ibrutinib therapy. 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. The identification was based on colonial morphology, capsules seen on India ink, urea test positivity, and MALDI TOF. 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.
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