Fungaemia due to Cryptococcus laurentii as a complication of immunosuppressive therapy--a case report.

Recently, infections caused by cryptococci non-neoformans have been increasingly recognized. Cryptococcus laurentii was previously considered saprophyte and thought to be non-pathogenic to humans. However, in favorable circumstances like diminished immunity, it seems to be an important pathogen. We present a case of fungaemia caused by Cryptococcus laurentii in a young man with membranoproliferative glomerulonephritis on aggressive immunosuppressive therapy. We also considered a tick-borne infection because of the endemic area of ticks' occurrence. Most cases of fungaemia caused by Cryptococcus laurentii were successfully treated with fluconazole. We still observed septic fever and positive microbiological blood tests after 3 weeks of treatment with fluconazole in our patient. Therefore, among the others, a computer tomography of abdomen was done, which revealed an inflammatory (presumably mycotic) focus near right lobe of the liver. Accordingly, we started treatment with itraconazole. Controlled microbiological blood tests after 5 weeks of itraconazole therapy were negative. Until now, only one case of fungaemia caused by Cryptococcus laurentii with use of itraconazole was reported. Such an unusual fungal infection needs guidelines dealing with earlier diagnosis, treatment and prophylaxis to protect immunocompromised hosts.