Asymptomatic Pulmonary Cryptococcosis and Tuberculosis Co-infection in an immunocompetent Host : A case report.

Pulmonary Cryptococcosis is rare fungal infection that most commonly occurs in immunocompromised host. However, with advancement in diagnostic approach like tissue biopsy, cryptococcal infections are now increasingly being recognised. In immunocompetent host, cryptococcal infection is often asymptomatic and rarely becomes disseminated. Symptom development in immunocompetent host largely depends on burden and virulence of pathogen. Due to similarities in clinical, radiological and pathological findings in Cryptococcosis, Tuberculosis and other fungal infections like Blastomycocosis, it is important to have a tissue biospy to confirm the diagnosis. The aim of this case report is to highlight the investigation necessary to diagnose both fungal infection and Tuberculosis due to similar clinical features in both. We report a case of Gene-Xpert positive Tuberculosis in Bronchoscopy/BAL and histopathology proven Pulmonary Cryptococcos in same patient. CT guided Biopsy report showed necrosis and scattered multinucleated giant cells with ill formed granuloma. Numerous intracellular and extra cellular variable sized yeast with narrow angle budding consistent with Cryptococcosis. Concurrent infection of Cryptococcosis and Tuberculosis is rarely reported. Co-infection delays diagnosis leading to increased mortality and morbidity in limited resource settings.4The similarities in clinical, radiological and pathological findings makes it even more difficult for early diagnosis. Tissue diagnosis is definitive in such case. Co-infection of Cryptococcosis with Tuberculosis has been overlooked overtime and needs to be considered by both clinicians and microbiologists while managing a patient.