RESUMO
Meningitis is the main manifestation of cryptococcosis in adult systemic lupus erythematosus (SLE) patients, and other organs and systems, such as the lungs, are rarely affected in this fungal infection. To our knowledge, no case of pulmonary cryptococcosis has been described in the pediatric lupus population. Therefore, we report herein one patient with childhood SLE (C-SLE) and Sjögren's syndrome overlap that presented encapsulated Cryptococcus yeast cells in lung tissue. A 14-year-old girl was diagnosed with C-SLE. At the age of 16 years and 5 months, she presented with fever, cough and dyspnea, without headache, vomiting, and also without signs of meningeal irritation or other clinical manifestations. She was being treated with mycophenolate mofetil, hydroxychloroquine and prednisone. Chest radiography and chest computer tomography showed a single nodule in the left posterior apex and three nodular lesions in the left hemithorax respectively. Bronchoalveolar lavage and transbronchial biopsy were normal and without isolation of bacteria or fungi. Voriconazole was empirically introduced for 21 days. Fifteen days after the first biopsy, she underwent open thoracotomy with surgical left lung biopsy and was diagnosed with pulmonary cryptococcosis. Voriconazole was replaced with oral fluconazole and this antifungal therapy was maintained with improvement of clinical manifestations and without marked alteration of radiological images. In conclusion, we report the first case of pulmonary cryptococcosis in Sjögren's and C-SLE patient with a satisfactory clinical response to antifungal therapy. Fungal infections should be excluded in the presence of lung nodules and etiological identification is required for proper treatment.
Assuntos
Criptococose/microbiologia , Pneumopatias Fúngicas/microbiologia , Lúpus Eritematoso Sistêmico/complicações , Infecções Oportunistas/microbiologia , Síndrome de Sjogren/complicações , Adolescente , Fatores Etários , Antifúngicos/uso terapêutico , Biópsia , Lavagem Broncoalveolar , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/imunologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/imunologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/imunologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Two dichromenoxanthones [1,6-dihydroxy-6',6'-dimethylpyrano(2',3':3,4)-6'',6''-dimethylpyrano(2'',3'':7,8)xanthone (brasilixanthone A) and 1,6-dihydroxy-6',6'-dimethylpyrano(2',3':2,3)-6'',6''-dimethylpyrano(2'',3'':7,8)xanthone (brasilixanthone B)], along with betulinic acid, friedelin, sitosterol and stigmasterol were isolated from the roots and stems of Tovomita brasiliensis. Their structures were characterized on the basis of 1H and 13C NMR spectral data, including 2D NMR experiments.