A 54-year-old male, labourer by occupation, presented to the outpatient department of a tertiary care health institute with the chief complaints of abdominal pain, chest pain, and phlegmy cough for a month. He also complained of decreased urinary output and lower limb swelling for 3 days. In addition, he recalled a significant history of fever lasting for 15-20 days 4 months back and intake of antitubercular therapy. He was a known smoker; however, he did not drink alcohol. At the time of admission, he was disoriented to time, place, and person. 
Physical examination revealed the pulse of 113 bpm, blood pressure of 80/50 mmHg, respiratory rate of 20 per minute, and room air SpO2 of 98%. He was also detected with pallor, icterus, and bilateral pedal edema. In addition, the central nervous system examination showed flapping tremors. In the cardiovascular system examination, no added sound was heard. However, bilateral basal crept and occasional rhonchi were heard on chest auscultation. On the abdomen examination, abdominal distension was observed; furthermore, the liver was palpable and non-tender.
The chest X-ray demonstrated heterogeneous opacity in the left upper lung zone with reticulonodular opacity in the bilateral lung zones (Figure 1). Ultrasound abdomen was suggestive of grade II fatty liver changes with increased echogenicity; however, no focal lesion was seen. The kidneys were normal in size, the cortical echotexture appeared to be raised, and corticomedullary differentiation was maintained. Accordingly, the ultrasound was suggestive of bilateral grade I renal parenchymal disease with mild ascites.
Based on the results of the rapid lateral flow dipstick test, the patient had a reactive anti-HCV antibody test (Tulip Diagnostics, Hyderabad, Telangana). A complete hemogram revealed a total leukocyte count of 16,850 cells per mm3. On differential leukocyte count, neutrophils, lymphocytes, monocytes, and basophils were obtained as 77.2%, 19.2%, 1.6%, and 2.0%, respectively. The liver function tests revealed increased total bilirubin, direct bilirubin, indirect bilirubin, serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, and alkaline phosphatase levels of 16.7 mg/dl, 11.59 mg/dl, 5.11 mg/dl, 47.5 IU/ml, 49.2 IU/ml, and 268.3 U/L, respectively. Furthermore, the prothrombin time, international normalized ratio, serum urea, serum creatinine, and uric acid were estimated at 17 sec, 1.37, 207.3 mg/dl, 4.33 mg/dl, and 9.3 mg/dl, respectively. Additionally, phosphate, calcium, potassium sodium, and chloride levels were measured at 8.0 mg/dl, 8.0 mg/dl, 5.1 mEq/l, 135.2 mEq/l, and 99 mEq/l, respectively.
During the course of hospital stay, the patient's blood pressure was constantly falling, and he was put on non-adrenaline and terlipressin for the maintenance of blood pressure. Differential diagnosis of HCV-related liver disease with hepatic encephalopathy, disseminated tuberculosis, and septic shock was made. He was started on ceftriaxone, azithromycin, vitamin K, and rifaximin. However, his condition did not improve even with a combination of antibiotics. Therefore, further escalation of antibiotics was planned.
Blood culture was sent to the microbiology lab for aerobic culture and sensitivity. The culture bottle signaled positive after 24 h of aerobic incubation in the BacT/ALERT 3D automated blood culture system (BioMerieux, Durham, N.C.). Variable sized (5-10 microm) encapsulated narrow-based budding yeast-like cells were seen in direct smear (Figure 2A). India ink preparation of blood culture sample aspirated from culture bottle showed budding yeast cells with a clear halo (Figure 2B). 
Creamy mucoid colonies were obtained in blood agar and Sabouraud dextrose agar after 48 h of aerobic incubation (Figure 2C). The isolate was identified by the MALDI biotyper (Bruker Daltonics, Germany) as Cryptococcus var grubii at a confidence interval of 2. The serum sample of the patient was also positive for lateral flow immunochromatographic test for cryptococcal antigen (CryptoPS, Biosynex, France) (Figure 2D). Patient's attendants denied for antifungal treatment because of financial constraints, and they were willing to leave against medical advice. The patient expired the same day before the initiation of any antifungal therapy.