Cryptococcus as a cause of proliferative glomerulonephritis in an immunodeficient HIV+ patient

This report presents the first proliferative glomerulonephritis (GN) induced by Cryptococcus neoformans in a human immunodeficiency virus (HIV)+ patient. While the patient was on medication against HBV, HIV RNA was found 4.25 × 105 in his blood. Six months later, he experienced headache, visual blurring, nausea, and vomiting and was hospitalised due to possible CMV, TBC, or HIV-related retinopathy and raised creatinine level. Cryptococcus neoformans grew in his blood culture. Albumin was 2.2 at that time. Because of the persistent proteinuria, kidney biopsy was applied. On histological examination, some glomeruli appeared normal, while endocapillary proliferative glomerulonephritis was seen in other glomeruli. Tubules were enlarged with many round yeasts. Mucicarmine stain confirmed peripheral capsule. Immunofluorescence staining with IgG, IgA, IgM, C3, C1q, fibrinogen, kappa, and lambda light chains revealed no deposition. Electron microscopy was not applied. The patient was well with 26 BUN (range 8-20 mg/dl) and 1.70 creatinin (range 0.84-1.25 mg/dl) five months after the biopsy date.

The most common secondary immunodeficiency is caused by HIV, and although different forms of renal disease were noted in this population, HIV-associated nephropathy (HIVAN) is the most common cause of renal failure in HIV1+ patients. The term HIVAN is reserved for the typical histopathological form of focal and segmental glomerulosclerosis. Cryptococcal GN was not reported in the glomeruli previously.