A case of pulmonary cryptococcosis followed by pleuritis in an apparently immunocompetent patient during fluconazole treatment

Izumikawa, Koichi; Zhao, Yong; Motoshima, Kohei; Takazono, Takahiro; Saijo, Tomomi; Kurihara, Sintaro; Nakamura, Shigeki; Miyazaki, Taiga; Seki, Masafumi; Kakeya, Hiroshi; Yamamoto, Yoshihiro; Yanagihara, Katsunori; Miyazaki, Yoshitsugu; Hayashi, Tomayoshi; Kohno, Shigeru

doi:10.1080/13693780802074494

Cited by 14 publications

(7 citation statements)

References 15 publications

(18 reference statements)

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“…Several previous studies have indicated that voriconazole is superior to other antifungal drugs in the treatment of C. neoformans, and they have confirmed the effectiveness of voriconazole in the treatment of PC and cerebral cryptococcosis [30][31][32][33]. Based on our experience, we recommend individualized regimens for the treatment of cryptococcosis and a complete treatment course is necessary.…”

Section: Discussionsupporting

confidence: 74%

Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Xie

Zeng

et al. 2012

Lung

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Section: Discussionsupporting

confidence: 74%

Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Xie

Zeng

et al. 2012

Lung

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“…Although cases of cryptococcosis have been reported in immunocompetent patients, cryptococcal pleurisy is rare (19,20). In the present case, multiple nodules were detected in both lungs, and cryptococcal bodies were identified in blood and bilateral pulmonary effusion cultures.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

et al. 2017

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A 73-year-old man with type 2 diabetes mellitus and end-stage renal disease was diagnosed with acute myocardial infarction. He required continuous dialysis after percutaneous coronary intervention. Subsequently, multiple nodules were discovered in both lungs for the first time, and Cryptococcus neoformans was isolated from the patient's sputum, blood, bilateral pleural fluid, and cerebrospinal fluid cultures, resulting in a diagnosis of disseminated cryptococcosis. This case represents an invaluable example of disseminated cryptococcosis with rapidly growing lung nodules in a dialysis patient, and illustrates that dialysis causes innate immune disorder and the reactivation of cryptococcosis.

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“…In this case, the atypical manifestation of the pleural effusion, along with the macroscopic observation and pathologiacl study, caused the early-stage misdiagnosis. In reference to cases reported in the literature, multiple plaques and nodules have been found on the pleural surface in most cases, and pathological findings of cryptococcal pleuritis have shown multiple yeast-like fungal bodies in the inflammatory granuloma [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review

Chen

Wang

et al. 2015

BMC Infect Dis

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BackgroundCryptococcus neoformans infection usually presents as chronic meningitis and is increasingly being recognized in immunocompromised patients. Presentation with pleural effusion is rare in cryptococcal disease; in fact, only 4 cases of pleural effusion as the initial clinical presentation in cryptococcosis have been reported in English-language literature to date. We report the first case of pleural effusion as the initial clinical presentation in a renal transplant recipient who was initially misdiagnosed with tuberculous pleuritis but who then developed fungaemia and disseminated cryptococcosis. The examination of this rare manifestation and the accompanying literature review will contribute to increased recognition of the disease and a reduction in misdiagnoses.Case presentationWe describe a 63-year-old male renal transplant recipient on an immunosuppressive regimen who was admitted for left pleural effusion and fever. Cytological examinations and pleural fluid culture were nonspecific and negative. Thoracoscopy only found chronic, nonspecific inflammation with fibrosis in the pleura. After empirical anti-tuberculous therapy, the patient developed an elevated temperature, a severe headache and vomiting and fainted in the ward. Cryptococci were specifically found in the cerebrospinal fluid following lumbar puncture. Blood cultures were twice positive for C. neoformans one week later. He was transferred to the respiratory intensive care unit (RICU) immediately and was placed on non-invasive ventilation for respiratory failure for 2 days. He developed meningoencephalitis and fungaemia with C. neoformans during hospitalization. He was given amphotericin B liposome combined with 5-flucytosine and voriconazole for first 11 days, then amphotericin B liposome combined with 5-flucytosine sustained to 8 weeks, after that changed to fluconazole for maintenance. His condition improved after antifungal treatment, non-invasive ventilation and other support. Further pathological consultation and periodic acid-Schiff staining revealed Cryptococcus organisms in pleural sections, providing reliable evidence for cryptococcal pleuritis.ConclusionPleural effusion is an unusual manifestation of cryptococcosis. Cryptococcal infection must be considered in the case of patients on immunosuppressives, especially solid-organ transplant recipients, who present with pleural effusion, even if pleural fluid culture is negative. Close communication between the pathologist and the clinician, multiple special biopsy section stains and careful review are important and may contribute to decreasing misdiagnosis.

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A case of pulmonary cryptococcosis followed by pleuritis in an apparently immunocompetent patient during fluconazole treatment

Cited by 14 publications

References 15 publications

Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis

Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review

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