Chizinga Mwelwa, Hussain Manzar, Taylor Katie, Kalra Saminder, Gupte Asmita, Canales Muna
Division of Pulmonary& Critical Care, University of Florida, College of Medicine, United States.
Division of Nephrology, University of Florida, College of Medicine, United States.
IDCases. 2020 May 21;21:e00838. doi: 10.1016/j.idcr.2020.e00838. eCollection 2020.
We report the case of a 71-year-old male with poorly controlled diabetes mellitus who presented with lower extremity edema and acute renal failure. He was diagnosed with nephrotic syndrome secondary to minimal change disease (MCD). Treatment with steroids was withheld due to concern for hyperglycemia in the context of his poorly controlled diabetes mellitus. A week after discharge, he was subsequently re-hospitalized four times within a month with pleural effusions, dyspnea, and fever. Work up revealed isolated cryptococcosis, demonstrated on two separate admissions. There was neither evidence of disseminated disease nor immunocompromising condition. Immunosuppression was not initiated for the treatment of MCD in the setting of poorly controlled diabetes and active infection. After six months of treatment with fluconazole 400 mg/day, the nephrotic syndrome, renal failure, and cryptococcal pleuritis resolved. This case is the first to our knowledge of isolated pleural cryptococcosis associated with nephrotic syndrome. The patient's course lends further support to the hypothesis that there may be causal relationship between cryptococcosis and nephrotic syndrome.
我们报告了一例71岁男性患者，其糖尿病控制不佳，出现下肢水肿和急性肾衰竭。他被诊断为继发于微小病变病（MCD）的肾病综合征。由于担心其糖尿病控制不佳的情况下使用类固醇会导致高血糖，因此未给予类固醇治疗。出院一周后，他在一个月内又因胸腔积液、呼吸困难和发热四次重新住院。检查发现两次单独入院时均确诊为孤立性隐球菌病。既没有播散性疾病的证据，也没有免疫功能低下的情况。在糖尿病控制不佳且存在活动性感染的情况下，未开始免疫抑制治疗MCD。在用400毫克/天氟康唑治疗六个月后，肾病综合征、肾衰竭和隐球菌性胸膜炎均得到缓解。据我们所知，该病例是首例与肾病综合征相关的孤立性胸膜隐球菌病。患者的病程进一步支持了隐球菌病与肾病综合征之间可能存在因果关系的假说。
