Cryptococcal lymphadenitis and massive splenomegaly in an immunocompromised patient

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.