Primary cryptococcal prostatitis in an apparently uncompromised host

BACKGROUND. Systemic spread from a primary focus of cryptococcal infection commonly involves the central nervous system, manifested as meningitis or m eningoencephalitis. Untreated meningitis and meningoencephalitis are invari ably fatal, following a subacute or chronic course of cyclic remission and relapse, followed by progressive deterioration over weeks to months. Occasi onal patients with fulminating meningoencephalitis die within a few days. I ncorrect diagnosis may be the most common cause of fatality in this disease . Thorough histopathologic examination and blood and body fluid studies sho uld minimize misdiagnosis. METHODS. We studied the case of an initially misdiagnosed 64-year-old appar ently immunologically competent man with primary cryptococcal prostatitis t hat subsequently disseminated to the central nervous system and the left ey e. All immunologic findings including workup for AIDS viruses were normal. Laboratory studies confirmed cryptococcal infection. RESULTS. After initial misdiagnosis, our patient received improper treatmen t for 10 months. He developed meningitis and severe left endophthalmitis wi th optic nerve and retinal involvement. Toxic medications led to kidney ins ufficiency with about 66% loss of function. Following therapy, reevaluation of his immune system showed marked abnormality in cell-mediated immunity. CONCLUSIONS, Cryptococcosis is easily misdiagnosed in uncompromised hosts, both clinically and pathologically, because of misconception that the disea se affects only immunocompromised individuals and that primary cryptococcal prostatitis is virtually unheard-of in "normal" males. (C) 1999 Wiley-Liss , Inc.