Cryptococcosis in Pregnancy With Placental Cryptococcosis in a Patient With AIds: Case Report

Cryptococcosis in pregnancy, particularly in patients with AIDS, has been rarely described and represents a highly complex therapeutic challenge, given the possibility of vertical transmission of cryptococcosis. The aim of this study is to report a case of a pregnant woman with AIDS and cryptococcosis with placental infection by Cryptococcus. A 29-year-old woman, in her sixth pregnancy, with one previous miscarriage, was diagnosed with HIV in the ninth week of this last pregnancy, when antiretroviral therapy (tenofovir/lamivudine + dolutegravir) was initiated. She was admitted with dry cough, later evolving with headache and progressive weakness. She had an HIV viral load of 300,000 copies/mL and a CD4 count of 75 cells/mm³. During initial investigation, serum cryptococcal antigen (CrAg) was positive, and urinary lipoarabinomannan and Histoplasma antigen were negative. Chest CT showed multiple small centrilobular nodules of varying attenuation (solid and subsolid) throughout the lung parenchyma; consolidation in the apical segment of the right upper lobe with air bronchogram and gas focus. Cranial CT revealed multiple nodular lesions with ring enhancement and vasogenic edema. Lumbar puncture was performed, with CSF showing negative CrAg and negative fungal cultures. The rapid molecular test for Mycobacterium tuberculosis was also negative. With the hypothesis of cryptococcosis involving lungs and central nervous system, liposomal amphotericin B plus flucytosine was started for four weeks as induction therapy. As it was not possible to exclude associated neurotoxoplasmosis, sulfamethoxazole + trimethoprim was initiated. She evolved with clinical improvement, with significant regression of pulmonary lesions and cerebral vasogenic edema. However, signs of fetal distress appeared on ultrasound, and cesarean section was indicated at 34 weeks of gestation. Placental analysis revealed positive culture for Cryptococcus neoformans. Newborn screening tests showed negative CrAg in both CSF and serum. The newborn’s HIV viral load was 52,400 copies/mL. This case reinforces the importance of expanded screening for opportunistic infections in pregnant women, strict adherence to antiretroviral therapy and targeted treatment. Placental involvement by cryptococcosis may be a potential marker of fetal impact, requiring early interventions.