Iwasaki Yukiko, Tominaga Masaki, Kuroki Shigetaka, Kato Osamu
Department of Internal Medicine, Saga Insurance Hospital.
Nihon Kokyuki Gakkai Zasshi. 2005 Feb;43(2):112-6.
We report a case of primary pulmonary cryptococcosis. A 43-year-old male, without any significant underlying disease or immunological abnormalities, was admitted to our hospital with a complaint of sudden onset of severe back pain. His chest-X-ray and computed tomography revealed infiltrative shadows in the left lower lung without any signs of pleural effusion. Through transbronchial biopsy, cryptococcosis was obtained. Cryptococcal antigen also tested positive, we diagnosed this case as primary pulmonary cryptococcosis. And started anti-fungal therapy (fluconazole) consisting of parenteral and oral fluconazole. As soon as anti-fungal therapy was started, both the chest X-ray findings and cryptococcal antigen showed general improvement. Furthermore, subjective symptoms subsided immediately after treatment, During follow up through the outpatient clinic, his symptomatic complaint and chest roentgenogram shows improvements. This case was noteworthy for two reasons: 1) In cases with chest X-rays showing infiltrative shadows but lacking any underlying diseases, pulmonary cryptococcosis should be considered. 2) Sudden onset of back pain is a rare but a possible primary symptom of pulmonary cryptococcosis.
我们报告一例原发性肺隐球菌病。一名43岁男性，无任何重大基础疾病或免疫异常，因突发严重背痛入院。他的胸部X线和计算机断层扫描显示左下肺有浸润性阴影，无胸腔积液迹象。通过经支气管活检，确诊为隐球菌病。隐球菌抗原检测也呈阳性，我们将此病例诊断为原发性肺隐球菌病，并开始抗真菌治疗（氟康唑），包括静脉注射和口服氟康唑。抗真菌治疗一开始，胸部X线表现和隐球菌抗原均显示总体改善。此外，治疗后主观症状立即消退，在门诊随访期间，他的症状主诉和胸部X线片均有改善。该病例有两点值得注意：1）胸部X线显示浸润性阴影但无任何基础疾病的病例，应考虑肺隐球菌病。2）突发背痛是肺隐球菌病罕见但可能的主要症状。
