Discussion
Disseminated Cryptococcus neoformans infection is a serious infection that can occur in immunocompromised patients. (7) During the outbreak of COVID-19 disease, there were many studies about the overwhelming immune response to COVID-19 infection through the activation of a large number of T lymphocytes and mononuclear macrophages, producing cytokines like interleukin-6 (IL-6), which bind to the receptor and cause cytokine storm and severe inflammation in the lung and other tissues. Tocilizumab, as an anti-human IL-6 receptor monoclonal antibody and immunosuppressant drugs, was recommended by several studies for alleviating the inflammatory response. (8)
Jean and colleagues have noted in their study of 52 patients withCryptococcus neoformans isolated from blood culture, the primary three predisposing for Cryptococcemia are Acquired immunodeficiency syndrome, immunosuppressive therapy and decompensated liver cirrhosis. (9) And in our case, the Cryptococcus neoformans was isolated from the blood culture. And according to Passerini M et al thatCryptococcus neoformans can affect different orangs as meningoencephalitis, which is the most common, followed by pulmonary and cutaneous disease. (10)
According to Jean et al that patients with positive blood culture forCryptococcus neoformans developed sepsis by 81%, including those developed septic shock, the lumbar puncture (LP) was positive in 61.5% of patients with positive blood culture for Cryptococcus neoformans and 84% of those with LP positive showed meningeal involvement, in our case LP was recommended but not done because the patient was critically sick and unstable. Also it was noted by Jean et al that the fatality within 30 days of Cryptococcemia was 37%. (9) Also, in our case, the patient died within 10 days of Cryptococcemia. Therefore, it is essential to suspect Cryptococcus neoformansinfection in an immunocompromised patient and early management, keeping in mind the high morbidity associated with it. Consequently, it is crucial to avoid misdiagnosis and mismanagement, keeping in mind the high morbidity.