INTERESTING IMAGE Cryptococcal Lymphadenitis and Massive Splenomegaly in an Immunocompromised Patient Zafer U ¨ nsal Coskun, MD,*† Dana Mathews, PhD, MD,* Paul Weatherall, MD,* Daniel Skiest, MD,‡ and Orhan K. O ¨ z, MD, PhD* Abstract: We report an unusual case of lymphadenitis and splenitis in a hemophiliac with AIDS. Splenomegaly without focal lesions was shown by CT and MRI. A Ga-67 scan demonstrated markedly increased activity in the spleen and increased focal activity in the left supraclavicular region. Cryptococcus neoformans was cultured from blood. A fine needle aspirate of a supraclavicular lymph node revealed budding yeast. After therapy, a repeat gallium scan showed no supraclavicular activity and markedly reduced splenic uptake. Cryptococcal infection should be in the differential diagnosis of markedly increased Ga-67 uptake in splenomegaly and focal lymph node uptake in an immunocompromised patient. Key Words: Cryptococcus, lymphadenitis, AIDS, splenomegaly, Ga-67 scintigraphy, MRI (Clin Nucl Med 2007;32: 314 –316) REFERENCES 1. Powderly WG. Cryptococcal meningitis and AIDS. Clin Infect Dis. 1993;17:837– 842. 2. Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N Engl J Med. 1989;321:794 – 799. 3. Kovacs JA, Kovacs AA, Polis M, et al. Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med. 1985;103:533–538. 4. Holtzer CD, Jacobson MA, Hadley WK, et al. Decline in the rate of specific opportunistic infections at San Francisco General Hospital, 1994 –1997. AIDS. 1998;12:1931–1933. 5. Sacktor N, Lyles RH, Skolasky R, et al. HIV-associated neurologic disease incidence changes: Multicenter AIDS Cohort Study, 1990 –1998. Neurology. 2001;56:257–260. 6. Das BP, Panda PL, Mallik RN, et al. Cryptococcal lymphadenitis and meningitis in human immunodeficiency virus infection—a case report. Indian J Pathol Microbiol. 2002;45(3):349 –351. 7. Blanche P, Gombert B, Ginsburg C, et al. HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by anti-inflammatory therapy. Scand J Infect Dis. 1998;30: 615– 616. 8. Darras-Joly C, Chevret S, Wolff M, et al. Cryptococcus neoformans infection in France: epidemiologic features of and early prognostic parameters for 76 patients who were infected with human immunodefi- ciency virus. Clin Infect Dis. 1996;23:369 –376. 9. Zuger A, Louie E, Holzman RS, et al. Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Diagnostic features and outcome of treatment. Ann Intern Med. 1986;104:234 –240. 10. Symmers W St. C. Lymphadenitis caused by infection and infestation. In: Henry K, Symmers W St. C, eds. Systemic Pathology. Thymus, Lymph Nodes, Spleen and Lymphatics, 3rd ed. Edinburgh: Churchill Livingstone; 1992. 11. Jayaram G, Chew MT. Fine needle aspiration cytology of lymph nodes in HIV infected individuals. Acta Cytol. 2000;44:960 –966. 12. Gupta SK, Chhabra R, Sharma BS, et al. Vertebreal cryptococcosis simulating tuberculosis. Br J Neurosurg. 2003;17:556 –559. 13. MacGregor DK, Citron D, Shahab I. Cryptococcal infection of the larynx simulating laryngeal carcinoma. South Med J. 2003;96:74 –77. 14. Sun LM, Chen TY, Chen WJ, et al. Cryptococcus infection in a patient with nasopharyngeal carcinoma: imaging findings mimicking pulmonary metastases. Br J Radiol. 2002;75:275–278. 15. Zanelli G, Sansoni A, Ricciardi B, et al. Muscular-skeletal cryptococ- cosis in a patient with idiopathic CD4+ lymphopenia. Mycopathologia. 2001;149:137–139. 16. Yip SK, Cheng C, Wong MY, et al. Cryptococcal prostatic abscess in an immunocompromised patient: a case report and review of the literature. Ann Acad Med Singapore. 1998;27:873– 876. Received for publication September 21, 2006; accepted December 20, 2006. From the *Department of Radiology, UT Southwestern Medical Center, Dallas, TX; †Gu ¨lhane Military Medical Academy, Ankara, Turkey; and ‡Internal Medicine, Baystate Medical Center, Springfield, MA. Reprints: Orhan K. O ¨ z, MD, PhD, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9153. E-mail: orhan.oz@utsouthwestern.edu. Copyright © 2007 by Lippincott Williams & Wilkins ISSN: 0363-9762/07/3204-0314 Clinical Nuclear Medicine • Volume 32, Number 4, April 2007 314