Images in Clinical Medicine
Human Immunodeficiency Virus Nephropathy and Intraglomerular Cryptococcus Neoformans
N Engl J Med 1998; 339:887September 24, 1998
- Article
Figure 1 A 24-year-old man with the acquired immunodeficiency syndrome presented in May 1997 with proteinuria and renal insufficiency. The most recent assessment of viral burden revealed a human immunodeficiency virus (HIV) type 1 RNA level of 62,000 copies per milliliter. In September 1996, Cryptococcus neoformans infection had been diagnosed on the basis of blood and cerebrospinal fluid cultures (cerebrospinal fluid findings: glucose, 55 mg per deciliter [3.1 mmol per liter]; protein, 17 mg per deciliter; 6 red cells; and 0 white cells). The patient received a cumulative dose of 4.5 g of intravenous amphotericin B but declined maintenance therapy. Subsequent blood cultures were negative, and serum cryptococcal antigen titers remained above 1:2000 without signs of meningitis. By May 1997, the serum creatinine concentration had gradually risen from 1.7 to 5.8 mg per deciliter (150 to 513 μmol per liter) and the 24-hour urinary protein excretion was 2.5 g. A kidney-biopsy specimen showed focal segmental glomerulosclerosis with podocyte hyperplasia and marked tubulointerstitial changes (microcysts, tubular atrophy, and interstitial lymphoid infiltrates) consistent with the presence of HIV nephropathy (periodic acid–Schiff, ×100). A few glomeruli contained yeast forms with thick capsules (arrows) that were positive on mucicarmine staining, a characteristic of C. neoformans (viable or dead forms). Electron microscopy did not reveal tubuloreticular structures or yeast forms. By June 1997, end-stage renal disease had developed and hemodialysis was necessary. The patient refused antimicrobial therapy for cryptococcus but has remained asymptomatic for 14 months.
Andrea Veatch, M.D.
Steven H. Dikman, M.D.
Mt. Sinai Hospital, New York, NY 10029- Citing Articles (1)
Citing Articles
1
Z. Dickson, F. Bocquentin, M. Essig, F. Paraf, J.-C. Aldigier, J.-P. Rerolle. (2009) A renal transplant recipient with intraglomerular Candida albicans. NDT Plus 2:4, 329-330
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