Wu Huan-Huan, Chen Yan-Xiao, Fang Shuang-Yan
Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China.
Department of Evidence-base Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China.
World J Clin Cases. 2020 Apr 6;8(7):1295-1300. doi: 10.12998/wjcc.v8.i7.1295.
Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals. However, the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients. In addition, the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules. Cavities and the halo sign are, however, prevalent in immunosuppressed patients. In immunocompetent patients, lung consolidation, pleural effusion or cavities are scarce.
A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month. As a chest computed tomography scan showed consolidation in his left lower lobe, he was initially diagnosed with pneumonia and received antibiotic treatment. A second review of the chest computed tomography image revealed multiple cavities and pleural effusion. Flexible fiberoptic bronchoscopy was subsequently performed, bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive. Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain. Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation, and periodic acid-Schiff staining showed red-colored yeast walls, signifying pulmonary cryptococcosis. The patient was then treated with a daily dose of fluconazole (0.4 g), but the cough and fever still persisted. We therefore changed treatment to voriconazole (0.2 g, twice a day), and the patient's clinical outcome was satisfactory.
Although rare, clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.
肺隐球菌病是一种机会性感染，主要发生在免疫功能低下的患者中，尽管有时也可发生于免疫功能正常的个体。然而，免疫功能正常宿主的肺隐球菌病影像学表现与免疫抑制患者不同。此外，孤立性肺隐球菌病最常见的影像学表现为单个或多个结节。然而，空洞和晕征在免疫抑制患者中较为常见。在免疫功能正常的患者中，肺实变、胸腔积液或空洞较少见。
一名29岁的亚洲男性因咳嗽、发热持续1个月入院。胸部计算机断层扫描显示左下叶实变，最初被诊断为肺炎并接受抗生素治疗。再次复查胸部计算机断层扫描图像发现多个空洞和胸腔积液。随后进行了纤维支气管镜检查，支气管肺泡灌洗液和血清隐球菌抗原检测均为阳性。支气管肺泡灌洗液墨汁染色可见隐球菌荚膜。左下叶经皮肺活检组织病理学检查进一步显示肉芽肿性炎症，高碘酸-希夫染色显示酵母细胞壁呈红色，提示肺隐球菌病。患者随后接受每日剂量氟康唑（0.4g）治疗，但咳嗽和发热仍持续。因此，我们将治疗改为伏立康唑（0.2g，每日2次），患者临床结局满意。
尽管罕见，但临床医生不应忽视无基础疾病的免疫功能正常宿主出现空洞和胸腔积液的可能性。
