Cryptococcic Bronchopneumonia

Abstract

CHICAGOCases are occasionally observed in the routine practice of the physician which are typical from the clinical standpoint but in which the laboratory findings are distinctly novel. Such cases are probably more frequent than a perusal of the medical literature would indicate, and they are therefore worth reporting.The following is a report, with laboratory findings, of a case in which the condition appeared clinically to be bronchopneumonia but in which Cryptococcus was isolated and none of the well known incitants of pneumonitis were present. REPORT OF A CASEHistory.\p=m-\H.P., a boy aged 10 years and 8 months, was well nourished and healthy. He had had measles, whooping cough, chickenpox and scarlet fever before he was 8 years old; his tonsils had been removed when he was 7, and he had had lobar pneumonia of six days' duration when he was 8, in 1933. Clinical Course.\p=m-\OnDec. 15, 1935, the patient had an infection of the upper respiratory tract and was kept in bed two days. On December 23 he still had a slight cough. In the afternoon of December 25 he had a chill lasting twenty minutes, and at 8 p. m. his temperature had risen to 103 F. He was first seen the morning of the twenty-sixth, at which time he had a severe pain on the left side in the lower part of the thoracic region. Examination revealed suppression of the breath sounds, bronchial breathing and diminished resonance in the lower left lobe and pleural friction rub in the axillary line. The child was markedly cyanosed ; his respiratory rate was 36. A diagnosis of lobar pneumonia was made. The course of the pneumonia from the third to the fourteenth day is shown in figure 1.On the fifth day of illness a second severe chill occurred, accompanied by extreme cyanosis and symptoms of collapse. Eight hours later the entire right lung showed extensive involvement. The cyanosis was so intense that the patient was placed in an oxygen tent, which greatly added to his comfort. Not until seven days later could he be removed from the tent without acquiring cyanosis and respiratory distress so marked that it was necessary to replace him in the tent. There was a marked nonproductive cough.

The Yeasts

“…It was nonpathogenic for rabbits. Black and Fisher (1937) reported isolating this yeast (in large numbers) from the nasopharynx of a boy suffering from bronchopneumonia; the cultures were made to obtain pneumococci for typing, since no sputum was obtained. Their strain did not kill rats, but produced lesions in the omentum from which the yeast was reisolated.…”