A rare сase of рulmonary сryptococcosis in a рatient with Wiskott–Aldrich syndrome infected with FLiRT COVID variant

The new COVID FLiRT vs. previous variant does not pose a greater danger; on the contrary, the new strain has a lower pathogenicity, although it is highly contagious. The article describes a rare case of pulmonary cryptococcosis in a patient with Wiskott-Aldrich syndrome co-infected with the FLiRT strain. Case description. Patient G.P., 31 years old, was in hospital for several hours. He was admitted for emergency indications with complaints of inhale chest pain, dry cough, and body temperature increased to 38°C. It is known from the medical history that the patient had been ill for about two weeks. In the last few days, before hospitalization, he noted a rise in body temperature to 37.3–38.1°C, and his cough worsened. In this regard, he called an ambulance and was taken to the emergency room for diagnosis and treatment. In childhood, he was diagnosed with Wiskott-Aldrich syndrome. In recent years, he presented no complaints from the internal organs. According to the epidemiological history, it was revealed that the patient did not travel to endemic regions 2 weeks before the onset of the disease, nor contact with people suspected of being infected with SARS-CoV-2, or patients whose diagnosis was confirmed by laboratory tests. A general blood test revealed leukocytosis, lymphopenia, an increase in procalcitonin to 4 ng/ml. Computed tomography of the chest organs revealed signs of interstitial pneumonia and small foci (2–7 mm) in the surrounding lung parenchyma. Despite the treatment started, a cough with discharged pinkish sputum suddenly began and death occurred. Autopsy showed alternation of moderately airy alveoli with focal emphysematous alveoli. In the lumen of the alveoli, leukocyte infiltration, edematous fluid, foci of granulomas with cryptococci, lymphohistiocytes, macrophages and single multinucleated giant cells were determined, on the interalveolar septa. Conclusion. Based on the pathological examination and the description of one of the presented cases, it can be assumed that the new COVID FLiRT variant in combination with Cryptococcus neoformans can lead to a severe form of the disease.