The Peripartum Immune Whiplash: Concomitant Cryptococcosis and Granulomatosis With Polyangiitis

We present a 19-year-old female, eight weeks postpartum, with a seven-week history of migratory arthralgias followed by progressive dyspnea and pleuritic chest pain. A large mass in her right lower lobe was discovered on computed tomography. Laboratory evaluation demonstrated elevated anti-proteinase 3 (PR3) antibody, along with elevated inflammatory markers. The bronchoalveolar lavage culture grew Cryptococcus neoformans, and serum cryptococcal antigen was positive. The patient was diagnosed with pulmonary cryptococcosis and treated with amphotericin and flucytosine, given the severity of her illness. Granulomatosis with polyangiitis was a part of the initial differential but was not diagnosed until she later developed transient hemoptysis, recurrent epistaxis, skin rash, and significant proteinuria. The skin biopsy was consistent with cutaneous vasculitis, and the kidney biopsy was positive for glomerulonephritis, confirming postpartum systemic vasculitis masked by a concurrent pulmonary cryptococcal infection.