Results
Histopathological findings (Figure 1): Alveolar spaces of both the right and left lungs were filled with round refractile structures with thick capsule suggestive of cryptococci. There were also few alveolar macrophages (Figure 1A and 1B). There were similar structures suggestive of cryptococci in brain tissues too (Figure 1C). Liver was unremarkable, whereas spleen had areas of extensive congestion along with dense infiltration by cryptococci (Figure 1D).
Peripheral blood smear was negative for malarial parasites. Serology was positive for HIV-1 antibodies by HIV-Tri Dot assay but the serological tests for dengue, malaria, HBsAg, HCV, Brucella and Leptospira were all negative. Microbiological findings (Figure 2): Gram stain of CSF sample revealed Gram positive round yeast cells suggestive ofCryptococcus spp (Figure 2A). Typical round encapsulated yeast forms suggestive of Cryptococcus spp were demonstrated by India ink preparation of CSF (Figure 2B). Colonies in Sabouraud dextrose agar were creamy, white and mucoid. Similarly, colonies on blood agar, chocolate agar and Sabouraud dextrose agar showed gram positive round budding yeast cells suggestive of Cryptococcus spp . Urease test was also positive after 48 hours of incubation. The most remarkable finding was Cryptococcus neoformans complex organism detected by CSF culture. Additionally, the lung tissue culture showed the growth of