A Rare Case of Lingual Cryptococcosis Presented as An Tongue Nodule in A HIV-Positive Patient

Abstract

Cryptococcus is an opportunistic fungal infection that primarily affects those with advanced HIV/AIDS. Oral manifestations are rare, and involvement of the tongue is exceptionally uncommon. Here, we present a rare case of lingual cryptococcosis in a 30-year-old male, who underwent treatment for cryptococcal meningitis presented with a papillary-like mass on the tongue. Given his history of advanced HIV and former smoking, oral malignancy or infection was initially considered. A subsequent biopsy of the tongue nodule collected firm tan soft tissue fragments. Histologic evaluation of the mass on H&E staining revealed squamous epithelium with subepithelial tissue containing round to oval yeasts with thick mucoid capsules, amidst mild inflammation. Focal ulceration and bacterial colonies were present on the epithelial surface. No evidence of malignancy can be identified. Periodic Acid-Schiff (PAS) and Grocott Methenamine Silver (GMS) stains highlighted abundant fungal organisms. Mucicarmine decorated the highly characteristic gelatinous capsules with bright pink color, consistent with cryptococcosis. This rare case of disseminated cryptococcosis involving the tongue in an HIV-positive patient highlights the need to consider fungal infections in atypical oral lesions. Oral cryptococcosis is uncommon and can easily be mistaken for more common conditions, such as neoplasms or bacterial infections. Our findings underscore the importance of considering fungal infections in the differential diagnosis of atypical oral lesions in immunocompromised patients and reinforce the role of biopsy in guiding timely diagnosis and management.

[N A J Med Sci. 2025;18(1):024-027.   DOI:  10.7156/najms.2025.1801024]

Key Words: Cryptococcus, Cryptococcosis, HIV, tongue, mucicarmine stain