Mark MM, Ng’ang’a AK, Omullo FP, Bereda G, Muchiri CT. Cryptococcal antigenemia during pregnancy: A case report. World J Obstet Gynecol 2026; 15(1): 115708 [DOI: 10.5317/wjog.v15.i1.115708]
Corresponding Author of This Article
Felix Pius Omullo, MD, MBChB, Senior Researcher, Department of Medical Services, Equity Afya, Kanaamkemer, Lodwar 399-30500, Turkana, Kenya. piuskirasia@gmail.com
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Obstetrics & Gynecology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 18, 2026 (publication date) through Feb 11, 2026
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Publication Name
World Journal of Obstetrics and Gynecology
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2218-6220
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Mark MM, Ng’ang’a AK, Omullo FP, Bereda G, Muchiri CT. Cryptococcal antigenemia during pregnancy: A case report. World J Obstet Gynecol 2026; 15(1): 115708 [DOI: 10.5317/wjog.v15.i1.115708]
World J Obstet Gynecol. Jan 18, 2026; 15(1): 115708 Published online Jan 18, 2026. doi: 10.5317/wjog.v15.i1.115708
Cryptococcal antigenemia during pregnancy: A case report
Maureen Mueni Mark, Allan Kariuki Ng’ang’a, Felix Pius Omullo, Gudisa Bereda, Charles Tung’ani Muchiri
Maureen Mueni Mark, Allan Kariuki Ng’ang’a, Department of Internal Medicine and Critical Care, Murang’a County Referral Hospital, Murang’a 69-10200, Murang’a, Kenya
Felix Pius Omullo, Department of Medical Services, Equity Afya, Lodwar 399-30500, Turkana, Kenya
Gudisa Bereda, Department of Pharmacy, ALERT Comprehensive Specialized Hospital, Addis Ababa 1000, Ethiopia
Charles Tung’ani Muchiri, Department of Obstetrics and Gynecology, Murang’a County Referral Hospital, Murang’a 69-10200, Kenya
Co-first authors: Maureen Mueni Mark and Allan Kariuki Ng’ang’a.
Author contributions: Mark MM contributed to conceptualization, data collection, and drafting of the manuscript; Ng’ang’a AK contributed to patient management, literature review, and critical revision; Omullo FP contributed to manuscript drafting, investigation, and resources; Bereda G contributed to supervision, validation, and manuscript review; Muchiri CT contributed to supervision, manuscript revision, and final approval.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Felix Pius Omullo, MD, MBChB, Senior Researcher, Department of Medical Services, Equity Afya, Kanaamkemer, Lodwar 399-30500, Turkana, Kenya. piuskirasia@gmail.com
Received: October 24, 2025 Revised: November 19, 2025 Accepted: December 25, 2025 Published online: January 18, 2026 Processing time: 83 Days and 9.1 Hours
Abstract
BACKGROUND
The management of asymptomatic cryptococcal antigenemia in pregnant women with advanced human immunodeficiency virus (HIV) disease presents a therapeutic dilemma. Clinicians must balance the risks of vertical transmission, immune reconstitution inflammatory syndrome (IRIS), and antifungal teratogenicity.
CASE SUMMARY
We report a case of a 28-year-old HIV-positive woman in Kenya who presented at 34 weeks of gestation with symptoms suggestive of meningitis. She had self-discontinued her antiretroviral therapy (ART) 18 months prior. Laboratory investigations confirmed a positive serum cryptococcal antigen (CrAg) with a high HIV viral load (41200 copies/mL). Lumbar puncture ruled out meningeal involvement. A multidisciplinary team initiated preemptive therapy with high-dose fluconazole (800 mg daily). Faced with her advanced gestation and the imperative to prevent perinatal transmission, a calculated risk was taken to initiate ART (tenofovir/lamivudine/dolutegravir) after only 7 days, a significant deviation from standard guidelines. At 36 weeks, she had a spontaneous vaginal delivery complicated by uterine inversion and postpartum hemorrhage, which was managed successfully. She did not develop cryptococcal IRIS. At 3-month follow-up, her viral load was suppressed (51 copies/mL), and her infant was HIV-negative with normal development at 6 months.
CONCLUSION
This case highlights the importance of routine CrAg screening in pregnant women with advanced HIV. Preemptive fluconazole in the third trimester is feasible. The timing of ART initiation may need individualization to prevent vertical transmission in late gestation, particularly in the context of isolated antigenemia, where the IRIS risk profile may differ from cryptococcal meningitis. These decisions require multidisciplinary input and close monitoring.
Core Tip: This case illustrates a high-stakes clinical dilemma in late pregnancy: Adhering to the standard 4-6 week antiretroviral therapy (ART) delay to prevent immune reconstitution inflammatory syndrome (IRIS) vs aggressively suppressing the human immunodeficiency virus viral load to prevent perinatal transmission. We demonstrate that for a woman presenting in the third trimester with isolated antigenemia, a truncated ART delay-supported by preemptive high-dose fluconazole and vigilant monitoring-was a calculated risk that achieved viral suppression for delivery without provoking IRIS. This case argues not for a new guideline, but for nuanced, individualized decision-making in complex scenarios, highlighting a critical evidence gap and the need to better define IRIS risk in pregnant women with antigenemia.
