The most common infection in patients positive for anti-interferon-gamma autoantibodies (anti-IFN-γ AAbs) is disseminated nontuberculous mycobacterial (dNTM) infection. Here, we report a rare case of triple infection caused by Cryptococcus, varicella-zoster virus (VZV), and nontuberculous mycobacterium in a patient with anti-IFN-γ AAbs. A 53-year-old Thai man presented with a progressively enlarging right cervical mass with low-grade fever and significant weight loss for 4 months. He also developed a lesion at his left index finger. A biopsy of that lesion showed granulomatous inflammation with yeast-like organisms morphologically consistent with cryptococcosis. Serum cryptococcal antigen was positive. Histopathology of a right cervical lymph node revealed chronic granulomatous lymphadenitis, and the lymph node culture grew Mycobacterium abscessus. One month later, he complained of vision loss in his left eye and subsequently developed a group of painful vesicles at the right popliteal area of S1 dermatome. Lumbar puncture was performed and his cerebrospinal fluid was positive for VZV DNA. His blood test for anti-HIV antibody was negative. Anti-IFN-γ AAbs was positive, but test for anti-granulocyte-macrophage colony-stimulating factor autoantibodies (anti-GM-CSF AAbs) was negative. He was treated with amphotericin B plus fluconazole for cryptococcosis; a combination of amikacin, imipenem, azithromycin, and levofloxacin for dNTM infection; and, intravenous acyclovir for disseminated VZV infection. After treatment, our patient’s fever and cervical lymphadenopathy were subsided, and his vision and visual acuity were both improved. This is the first case of triple infection with cryptococcosis, VZV, and dNTM in a patient who tested positive for anti-IFN-γ AAbs and negative for anti-GM-CSF AAbs. This case will increase awareness and heighten suspicion of these infections in patients with the described presentations and clinical characteristics, and this will accelerate diagnosis and treatment.

中文翻译：

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抗干扰素-γ自身抗体患者中隐球菌，水痘带状疱疹病毒和脓肿分枝杆菌的三重感染：病例报告。

抗干扰素-γ自身抗体（抗-IFN-γAAbs）呈阳性的患者中最常见的感染是散布性非结核分枝杆菌（dNTM）感染。在这里，我们报告了在抗IFN-γAAbs患者中由隐球菌，水痘带状疱疹病毒（VZV）和非结核分枝杆菌引起的三重感染的罕见病例。一名53岁的泰国男子表现为右颈重量逐渐增大，伴有低烧和体重明显减轻，持续了4个月。他的左手食指也出现了病变。对该病灶的活检显示肉芽肿性炎症，酵母样生物在形态上与隐球菌病一致。血清隐球菌抗原为阳性。右颈淋巴结的组织病理学显示为慢性肉芽肿性淋巴结炎，且淋巴结培养物中脓肿分枝杆菌生长。一个月后，他抱怨左眼视力下降，随后在S1皮肤刀的右pop区形成了一组疼痛的囊泡。进行了腰椎穿刺术，其脑脊液VZV DNA呈阳性。他的抗HIV抗体验血结果为阴性。抗IFN-γAAbs呈阳性，但抗粒细胞巨噬细胞集落刺激因子自身抗体（抗GM-CSF AAbs）测试为阴性。用两性霉素B加氟康唑治疗隐球菌病。阿米卡星，亚胺培南，阿奇霉素和左氧氟沙星的组合用于dNTM感染；静脉注射阿昔洛韦，用于传播VZV感染。治疗后，患者的发烧和颈淋巴结肿大得到缓解，其视力和视力均得到改善。这是三重隐球菌感染的第一例，一名患者的VZV和dNTM检测为抗IFN-γAAb阳性，而抗GM-CSF AAb阴性。具有这种描述和临床特征的患者将提高对这些感染的认识并提高对这些感染的怀疑，这将加快诊断和治疗。