Cryptococcal pericarditis with unexplained lymphadenopathy in an immunocompetent patient: a case report.

Objective: To present a rare case of cryptococcal pericarditis with unexplained multiple lymphadenopathies in an immunocompetent patient. Background: Fungal pericarditis is an uncommon infection that may result from hematogenous dissemination, direct extension, or iatrogenic inoculation. Cryptococcal pericarditis typically occurs in immunocompromised hosts and is exceedingly rare in immunocompetent individuals. We describe a case of cryptococcal pericarditis with multiple lymphadenopathies in an immunocompetent patient. Case Report: A 40-year-old male with no underlying disease or history of high-risk behaviors presented with chronic cough and sputum production. Imaging revealed bilateral pulmonary lesions, widespread lymphadenopathy, and pericardial effusion. Serum and pericardial fluid cryptococcal antigen tests were positive. HIV testing (fourth-generation antigen/antibody ELISA) was negative, and immunologic evaluation was unremarkable. Pericardiocentesis drained 585 mL of effusion. The patient was treated with intravenous antifungal therapy with fluconazole (0.4 g daily) for 1 week, followed by oral fluconazole for 4 months. Follow-up echocardiography performed 2 weeks after discharge revealed no significant pericardial effusion, whereas a subsequent at 4 months after discharge demonstrated a small residual effusion. The patient's cough and sputum production had also improved. Throughout the hospitalization and post-discharge period, the patient was able to maintain normal physical activity without functional limitations. Conclusions: This report presents a rare case of cryptococcal pericarditis with unexplained multiple lymphadenopathies in an immunocompetent patient, highlighting that fungal infection should be considered even in immunocompetent hosts with pericarditis.