Song Jae Chun, Kim Sang Kyum, Kim Eak Seong, Jung In Su, Song Young Goo, Yu Jeong Sik, Park Hyo Jin
Departments of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2008 Oct;52(4):255-60.
We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year- old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual.
我们遇到了一例罕见的结肠隐球菌病,患者看似免疫功能正常。一名27岁女性因间歇性黑便入住我院。最初的腹部CT扫描显示一个肿块病变阻塞了升结肠的大部分管腔。结肠镜检查显示升结肠近端有巨大的溃疡性真菌样肿块。进行了结肠镜活检,病理诊断为结肠隐球菌病,PAS染色阳性。评估免疫状态的实验室检查和骨髓检查均正常。患者接受了四周的静脉注射两性霉素B治疗,随后口服氟康唑六个月。在治疗开始后的四周和七个月进行了随访腹部CT扫描和结肠镜检查。静脉注射两性霉素B治疗结束后,腹部CT和结肠镜检查显示肿块病变缩小。七个月后,腹部CT和结肠镜检查显示结肠病变几乎完全消退,因此治疗结束。健康个体患隐球菌病是一种罕见疾病,仅有几例关于肺部或中枢神经系统受累的散发病例报告。因此,我们报告了一例看似免疫功能正常个体的结肠隐球菌病病例。