Inaba Atsushi, Okada Akira, Yoshida Taiko, Itoyama Satoshi, Nakai Tatsuro, Hisada Tetsuya, Takano Hideki
Department of Respiratory Medicine, Tokyo Teishin Hospital, Japan.
Intern Med. 2017;56(3):377-380. doi: 10.2169/internalmedicine.56.7438. Epub 2017 Feb 1.
A 73-year-old man with type 2 diabetes mellitus and end-stage renal disease was diagnosed with acute myocardial infarction. He required continuous dialysis after percutaneous coronary intervention. Subsequently, multiple nodules were discovered in both lungs for the first time, and Cryptococcus neoformans was isolated from the patient's sputum, blood, bilateral pleural fluid, and cerebrospinal fluid cultures, resulting in a diagnosis of disseminated cryptococcosis. This case represents an invaluable example of disseminated cryptococcosis with rapidly growing lung nodules in a dialysis patient, and illustrates that dialysis causes innate immune disorder and the reactivation of cryptococcosis.
一名73岁的2型糖尿病合并终末期肾病男性被诊断为急性心肌梗死。经皮冠状动脉介入治疗后，他需要持续透析。随后，首次在双肺发现多个结节，从患者的痰液、血液、双侧胸腔积液和脑脊液培养物中分离出新型隐球菌，诊断为播散性隐球菌病。该病例是透析患者中伴有快速生长的肺结节的播散性隐球菌病的一个宝贵实例，表明透析会导致先天性免疫紊乱和隐球菌病的重新激活。
