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Cryptococcosis is a fungal infection that may arise in immunocompromised or immunocompetent individuals. This case report seeks to demonstrate the difficulty in diagnosing and treating cryptococcosis based on clinical presentation and radiographic features as together, they mimic other pathological conditions. A 56-year-old female with cirrhosis presented with persistent abdominal pain, dyspnea, vomiting, and diarrhea and was diagnosed with pulmonary cryptococcosis after an initial diagnosis of bacterial pneumonia. With no improvement following antibiotic therapy for suspected bacterial pneumonia, additional imaging was performed with a confirmatory lung biopsy for pulmonary cryptococcosis. The patient initiated antifungal therapy with the anticipation of completing approximately 12 months with follow-up imaging to evaluate improvement. After the patient experienced adverse effects of antifungal therapy and did not achieve significant improvement or recovery in her condition, it was apparent that cryptococcal pneumonia presents both diagnostic and management challenges that must be further explored.
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Cryptococcal pneumonia is identified as a fungal infection of the lungs, with Cryptococcus neoformans and Cryptococcus gattii as the most common culprits. Cryptococcus neoformans primarily affects immunocompromised individuals while Cryptococcus gattii infections occur mostly in immunocompetent hosts. We present a 76-year-old male on ibrutinib due to a history of chronic lymphocytic leukemia who had multiple hospitalizations for pneumonia and was later diagnosed with cryptococcal pneumonia through positive bronchoalveolar lavage fungal culture and lymph node biopsy.
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Cryptococcal infection can cause significant morbidity and mortality in immunocompromised patients. We present a patient who was diagnosed with cryptococcal meningitis and pulmonary disease in the setting of a history of renal transplantation. The diagnosis was made based on growth of Cryptococcus neoformans in blood cultures and identification of cryptococcal antigen (CrAg) in cerebral spinal fluid (CSF) using a lateral flow assay (LFA). Our case is unique since the initial serum CrAg was falsely negative due to excess cryptococcal antigen preventing the formation of antigen-antibody complexes, referred to as the postzone phenomenon. This phenomenon has been reported on CSF samples but rarely reported on serum samples in patients without an HIV diagnosis.
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Cryptococcosis is a common fungal infection regarded as a disease of immunocompromised patients with high mortality. Cryptococcosis is usually observed in the central nervous system and lungs. However, other organs may be involved such as skin, soft tissue, and bones. Disseminated cryptococcosis is defined as fungemia or the involvement of two distinct sites. Here, we report the case of a 31-year-old female patient with disseminated cryptococcosis with neuro-meningeal and pulmonary involvement revealing a human immunodeficiency virus (HIV) infection. Chest computed tomography scan showed a right apical excavated lesion, pulmonary nodules, and mediastinal lymphadenopathy. Concerning biological tests, hemoculture, sputum, and cerebrospinal fluid (CSF) culture were positive for Cryptococcus neoformans. The latex agglutination test for cryptococcal polysaccharide antigen was positive in CSF and serum and HIV infection was confirmed by serological testing. The patient did not respond to initial antifungal therapy with amphotericin B and flucytosine. Despite the adaptation of antifungal treatment, the patient died of respiratory distress.
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BACKGROUND: Opportunistic infections associated with immunosuppressive treatments for inflammatory bowel disease pose an important safety concern. Here we report the case of a patient with active ulcerative colitis and cryptococcal pneumonia who was treated with vedolizumab combined with fluconazole. CASE PRESENTATION: A 56-year-old Japanese man with ulcerative colitis and a history of Sweet's syndrome who was taking prednisolone and azathioprine presented with a moderate exacerbation of ulcerative colitis, abdominal pain, diarrhea, and bloody stools along with cytomegalovirus infection. Increasing the prednisolone dose without using antiviral drugs improved cytomegalovirus infection; however, ulcerative colitis did not improve, and cryptococcal pneumonia occurred. Thus, treatment with fluconazole followed by vedolizumab was initiated for ulcerative colitis. The patient gradually recovered and achieved clinical remission without the exacerbation of pneumonia. CONCLUSIONS: We reported the first case of a patient with ulcerative colitis who was treated with vedolizumab and concomitant fluconazole for active cryptococcal pneumonia. Vedolizumab constitutes a high-potential treatment regimen owing to its safety in inflammatory bowel disease associated with opportunistic infections.
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Colite Ulcerativa , Infecções por Citomegalovirus , Doenças Inflamatórias Intestinais , Infecções Oportunistas , Masculino , Humanos , Pessoa de Meia-Idade , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Fluconazol/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Prednisolona/uso terapêutico , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológicoRESUMO
Patients with RET fusions represent 1-2% of all cases of non-small cell lung cancer (NSCLC), the majority of whom are younger, and are extremely rare in the elderly. As a selective RET inhibitor, pralsetinib has been shown to be efficacious and well-tolerated in patients with RET-fusion NSCLC. Nevertheless, there are currently insufficient data available for assessing the activity and safety of pralsetinib in elderly patients with NSCLC. Herein, we report an 81-year-old NSCLC patient with KIF5B-RET fusion, who achieved stable disease for more than 9 months at a low-dose of pralsetinib as second-line therapy. Of particular note, during pralsetinb therapy, his clinical course was complicated by cryptococcal pneumonia and staphylococcus aureus lung abscess. Our study demonstrates that pralsetinib is an effective therapeutic option that provides survival benefits for elderly NSCLC patients harboring RET fusion. However, during pralsetinb therapy, treating physicians should maintain particular vigilance for the increased risk of infection, especially in elderly patients.
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BACKGROUND: Specific pulmonary infection could seriously threaten the health of pilots and their companions. The consequences are serious. We investigated the clinical diagnosis, treatment, and medical identification of specific pulmonary infections in naval pilots. CASE SUMMARY: We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections, who had accepted treatment at the Naval Medical Center of Chinese People's Liberation Army between January 2020 and November 2021, including three cases of tuberculosis and one of cryptococcal pneumonia. All cases underwent a series of comprehensive treatment courses. Three cases successfully obtained medical waiver for flight after being cured, while one was grounded after reaching the maximum flight life after being cured. CONCLUSION: Chest computed tomography scanning should be used instead of chest radiography in pilots' physical examination. Most pilots with specific pulmonary infection can be cured and return to flight.
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Cryptococcosis is a devastating fungal disease associated with high morbidity and mortality even when treated with antifungal drugs. Bionized nanoferrite (BNF) nanoparticles are powerful immunomodulators, but their efficacy for infectious diseases has not been investigated. Administration of BNF nanoparticles to mice with experimental cryptococcal pneumonia altered the outcome of infection in a dose response manner as measured by CFU and survival. The protective effects were higher at lower doses, with reductions in IL-2, IL-4, and TNF-α, consistent with immune modulation whereby reductions in inflammation translate into reduced host damage, clearance of infection, and longer survival.
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Criptococose , Cryptococcus neoformans , Animais , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Inflamação , Camundongos , Fator de Necrose Tumoral alfaRESUMO
BACKGROUND AND AIM: Cryptococcal yeast cells are spread across different ecosystems through bird movement and are deposited in bird guano. These cells may be inhaled by humans and lead to cryptococcal pneumonia. In individuals with reduced immune T-cell populations, cells may disseminate to the brain and cause the often-deadly cryptococcal meningitis. In this study, we surveyed cryptococcal cells in bird droppings across the city of Bloemfontein, South Africa. MATERIALS AND METHODS: We aseptically collected 120 bird dropping samples from 15 representative city sites. In the laboratory, samples were assessed with regards to location, weighed, and standardized to a mass of 1 g before suspension in 10 mL phosphate buffer saline. Samples were first screened usingCalcofluor-white stain as it is a rapid technique for the detection of fungi via binding to cell wall components such as chitin. After this, positive Calcofluor samples were serologically assayed for the cryptococcal antigen (CrAg). To confirm assay data, CrAg positive samples were then cultured on bird seed agar and resulting colonies were assessed using Indian ink. RESULTS: We determined that 10/15 locations were positive for the CrAg. Pathogenic cells were identified on bird seed agar as brown colonies. When examined using microscopy, brown colony cells exhibited characteristic thick capsules representative of cryptococcal cells. CONCLUSION: This is the first proximate analysis showing the ecological distribution of cryptococcal cells in Bloemfontein. This is important as associated infections are acquired from the environment. Similarly, given the threat posed by cryptococcal cells to immunocompromised individuals, local authorities must initiate measures curbing the spread of these cells.
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BACKGROUND: Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, and few cases combine with Crohn's disease. We present the first SLE patient concurrent with Crohn's disease and rectovaginal fistula. She was successfully treated with vedolizumab and surgical intervention. Besides, she also had a rare opportunistic infection, cryptococcal pneumonia, in previous adalimumab treatment course. CASE: A 57 year-old female had SLE in disease remission for 27 years. She suffered from progressive rectal ulcers with anal pain and bloody stool, and Crohn's disease was diagnosed. She received adalimumab, but the lesion still progressed to a rectovaginal fistula. Besides, she suffered from an episode of cryptococcal pneumonia under adalimumab treatment course. Therefore, we changed the biologics to vedolizumab, and arrange a transverse colostomy for stool diversion. She had clinical remission without active inflammation, but the fistula still persisted. Then, she received a restorative proctectomy with colo-anal anastomosis and vaginal repair. Follow-up endoscopy showed no more rectal ulcers or fistula tracts, and contrast enema also noted no residual rectovaginal fistula. CONCLUSION: When a SLE patient had unusual rectal ulcers, Crohn's disease should be considered. Biologics combined with surgical intervention is an optimal solution for Crohn's disease with rectovaginal fistula. Although cryptococcal pneumonia is a rare opportunistic infection in the biological treatment, we should always keep it in mind.
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Doença de Crohn , Lúpus Eritematoso Sistêmico , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pessoa de Meia-Idade , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Resultado do TratamentoRESUMO
We report a case of cryptococcal pneumonia in a 53 years old female Nepali patient with uncontrolled diabetes mellitus type 2 who empirically received multiple broad-spectrum antibiotics and standard anti-tubercular treatment as well as glucocorticosteroids for suspected sarcoidosis before the diagnosis was finally established. To our knowledge, this is the first confirmed autochthonous case of cryptococcosis reported from Nepal.
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Criptococose/diagnóstico , Criptococose/epidemiologia , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Cryptococcus neoformans , Feminino , Fluconazol/uso terapêutico , Humanos , Pessoa de Meia-Idade , NepalRESUMO
We present a 27-year-old lady with HIV-1 infection who died due to rapidly worsening respiratory failure one day after commencing amphotericin B deoxycholate therapy for cryptococcal meningitis. Chest x-ray appearances were consistent with pneumocystis pneumonia but post mortem examination showed evidence of severe necrotizing cryptococcal pneumonia. Cryptococcal pneumonia is an underrecognized condition and should be considered in the differential of patients with HIV-1 infection and low CD4 count who develop respiratory symptoms.