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Case Series
Cryptococcus in the absence of immunosuppression: Diagnostic and therapeutic challenges
1 Department of Infectious Disease, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
2 Department of Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Salma Gayed
Department of Medicine, Division of Infectious Disease, The University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, North Carolina 27514,
USA
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Article ID: 100021Z16SG2026
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Gayed S, Schworer S, Yalin E, Stromberg J, Herce M. Cryptococcus in the absence of immunosuppression: Diagnostic and therapeutic challenges. J Case Rep Images Infect Dis 2026;9(1):13–18.ABSTRACT
Invasive cryptococcal infections, particularly those caused by Cryptococcus neoformans, are significant contributors to morbidity and mortality among immunocompromised patients, especially individuals living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Recognized as a critical fungal pathogen by the WHO in 2022, the increasing prevalence of such infections raises concerns, particularly as case reports emerge detailing instances in seemingly immunocompetent individuals. Here we report two cases, one in which the host had no known immunocompromising condition at time of diagnosis, and the other in which invasive infection was found without clear evidence of pulmonary or neurological involvement. We discuss the evolving epidemiology and diverse manifestations of invasive cryptococcal infections, and emerging associations with conditions that may predispose to infection in the seemingly immunocompetent host. These cases highlight disseminated cryptococcosis in patients without traditional severe immunosuppression, emphasizing the need for high clinical suspicion.
Keywords: Cryptococcus neoformans, Diffuse large B-cell lymphoma, Disseminated cryptococcosis, NASH cirrhosis, Non-HIV immunosuppression
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Author Contributions
Salma Gayed - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Stephen Schworer - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Final approval of the version to be published
Elgin Yalin - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joseph Stromberg - Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Michael Herce - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Salma Gayed et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
