Cryptococcosis in B-cell acute lymphoblastic leukemia with suspected dissemination: A case report

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. With improved risk stratification and MRD-guided therapy, the overall prognosis of ALL is more than 90 %. Nevertheless, Induction mortality remains a significant clinical concern in low- and middle-income countries (LMIC), with invasive fungal infection (IFI) of increasing concern. We present a case of a 9-year-old boy with B-cell acute lymphoblastic leukemia (B-ALL) who developed persistent fever due to IFI during induction chemotherapy. Despite hematologic remission, he developed IFI of the kidneys with subacute thyroiditis suspicious for disseminated infection, necessitating modification of chemotherapy and prolonged antifungal therapy. This case highlights the diagnostic challenges in IFI management in pediatric leukemia in LMIC.