Probable disseminated cryptococcosis relapse in a patient with Hodgkin's lymphoma treated with induction therapy resumption and autologous stem cell transplant

Cryptococcus species are fungi that primarily cause infections in immunocompromised patients. In cases of hematologic malignancies, it can result in central nervous system and disseminated infections which are associated with high morbidity and case-fatality rate. We present the case of a patient with Hodgkin's lymphoma who experienced a probable relapse in disseminated cryptococcosis during the consolidation phase of treatment. After prolonged induction therapy with amphotericin B and flucytosine, followed by isavuconazole maintenance, the patient achieved a favourable outcome. Six months after relapse of cryptococcosis, the patient underwent autologous stem cell transplantation (ASCT), which resulted in sustained lymphoma remission. The cryptococcosis was successfully contained. This case highlights the need for clinicians to consider reintroducing IT in patients who experience clinical and radiological worsening during the consolidation phase. The patient demonstrated sustained clinical and radiological improvement at seven months post-ASCT, notwithstanding the presence of active cryptococcosis. This suggests that ASCT appears to be safe and feasible when the prognosis of the underlying hematological malignancy warrants its use.