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June 17, 2026Diagnostic Microbiology and Infectious DiseaseOpen Access

When the Test Lies: Fatal Cryptococcosis and the Prozone Effect in Advanced HIV Infection

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Authors

MCMylene CostaPRPatrícia RodriguesBABeatriz Araújo

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Overview

Randomized trial shows false-negative cryptococcal antigen results in advanced HIV, indicating critical diagnostic pitfalls.

Key Points

  • This case aims to highlight the diagnostic challenges posed by the prozone effect during cryptococcal antigen testing in advanced HIV infection.
  • Patient presented with advanced HIV infection (CD4+ count 26 cells/µL) and altered mental status.
  • Initial cryptococcal antigen detection by lateral flow assay (LFA) was negative, prompting serial dilution testing.
  • Cultures confirmed cryptocococcus neoformans in cerebrospinal fluid and skin biopsy.
  • Initial CrAg LFA was negative, but positive results were obtained at 1:10 and 1:20 dilutions in serum and 1:40 in CSF.
  • Despite antifungal therapy with liposomal amphotericin B and flucytosine, the patient died from neurological deterioration.
  • The case illustrates the importance of recognizing the prozone effect in diagnostics.

Cite This Study

Costa et al. (2026) studied this question.

synapsesocial.com/papers/6a323915d50b63ecad204b14https://doi.org/10.1016/j.diagmicrobio.2026.117512
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