When infection masquerades as cancer: a case report of disseminated cryptococcosis

Abstract Introduction Disseminated cryptococcosis is a rare and serious fungal infection, typically seen in immunocompromised individuals. Its presentation in immunocompetent patients is uncommon and can mimic malignancies, such as lymphoproliferative disorders. Here we report a case of an elderly female with symptoms suggestive of malignancy but was diagnosed with disseminated cryptococcosis. Case presentation A 62-year-old apparently immunocompetent woman presented with drowsiness, fever, generalized weakness, and an 8 kg weight loss over six months. Imaging studies, including PET-CT, revealed FDG-avid lymphadenopathy and splenomegaly. Cerebrospinal fluid analysis confirmed cryptococcal meningoencephalitis, and a supraclavicular lymph node biopsy identified disseminated cryptococcosis with fungal elements. Despite extensive investigations, no immunosuppressive risk factors were identified. The patient was treated with liposomal Amphotericin B and oral Fluconazole. However, the patient did not survive. Discussion Though uncommon, disseminated cryptococcosis can present similarly to malignancies in immunocompetent individuals. The use of imaging alone is insufficient for diagnosis. Instead, histopathological and microbiological confirmation is crucial to avoid misdiagnosis and ensure timely antifungal therapy. Conclusion Disseminated cryptococcosis is a rare but important differential diagnosis in patients with systemic lymphadenopathy and CNS involvement, regardless of immune status.