Wee Audrey Chuan Rui, Seet Ju Ee, Venkatalacham Jonathen, Tan Sze Khen
Department of Respiratory and Critical Care Medicine Khoo Teck Puat Hospital Singapore.
Department of Pathology National University Health System Singapore.
Respirol Case Rep. 2018 Jan 10;6(3):e00294. doi: 10.1002/rcr2.294. eCollection 2018 Apr.
Cryptococcal pleural infection is rare with about 50 cases reported. It tends to occur in immunocompromised individuals. We describe a 38-year-old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treated for pleural tuberculosis, but presented again with worsening pleural effusion 6 weeks later. A thoracoscopic pleural biopsy revealed chronic nodular granulomatous pleuritis with cryptococcal organisms present. The repeat pleural fluid culture was positive for . He was started on intravenous amphotericin B and oral flucytosine for 1 week, and then continued on oral fluconazole. He was subsequently diagnosed to have acute myeloid leukaemia. His peripheral blood film showed presence of blast cells (33%), with flow cytometry showing increased myeloblast population. Lymphocytic exudative pleural effusions with raised ADA levels in an immunocompromised patient can be due to opportunistic fungal infections.
隐球菌性胸膜感染较为罕见，据报道约有50例。它往往发生在免疫功能低下的个体中。我们描述了一名38岁男性，他表现为淋巴细胞性渗出性右侧胸腔积液，且胸腔积液腺苷脱氨酶（ADA）水平升高。他最初被诊断为胸膜结核并接受治疗，但6周后因胸腔积液恶化再次就诊。胸腔镜胸膜活检显示为慢性结节性肉芽肿性胸膜炎，存在隐球菌。胸腔积液复查培养结果为阳性。他开始静脉注射两性霉素B和口服氟胞嘧啶1周，然后继续口服氟康唑。他随后被诊断为急性髓系白血病。他的外周血涂片显示有原始细胞（33%），流式细胞术显示髓母细胞群体增加。免疫功能低下患者出现淋巴细胞性渗出性胸腔积液且ADA水平升高可能是由于机会性真菌感染。
