Cryptococcal prostatic abscess in a HIV infected patient with immune reconstitutition inflammatory syndrome

Immune reconstitution inflammatory syndrome is a phenomenon that occurs after initiation of treatment for chronic immunosuppressive illnesses such as human immunodeficiency virus (HIV), tuberculosis and hepatitis B infections. Immune-system resumes activity and results in unmasking of occult infections or worsening of existed infections. We came across a case of a 35-year-old man who was diagnosed with HIV infection with pulmonary tuberculosis. He was started on anti-tubercular treatment initially followed by anti-retroviral treatment 2 weeks later. After a fortnight, he presented with a febrile illness with urinary retention. Clinically, tender enlarged prostate was felt on per rectal examination. On radiological workup, he was found to have focal lesions in the prostate, suggestive of the abscess. Subsequently, the patient underwent transurethral resection of prostate and tissue was sent for histopathological examination. Initially, we suspected tuberculosis but the biopsy report revealed cryptococcal prostatic abscess. The patient was managed with amphotericin B followed by fluconazole. Clinically and radiologically, he improved well.