Overwhelming cryptococcal infection detected by bone marrow examination

A 37-year-old homosexual man was admitted to an accident and emergency department in extremis. He had a cardiac arrest and died shortly afterwards. A history from his flatmate was of non-specific malaise with episodic confusion and disorientation for about a month. He was not known to be HIV-antibody positive. Bone marrow aspirate and trephine specimens taken post mortem showed numerous organisms of Cryptococcus neoformans with no granulomatous response. The aspirate has been stained with Grocott's methenamine silver stain (left) and the trephine specimen with haematoxylin and eosin (right). Blood cultures taken just before death grew Cryptococcus neoformans and an HIV antibody test was positive.