Department of Internal Medicine, Fukuyama City Hospital, Japan.
Intern Med. 2020 Oct 15;59(20):2547-2551. doi: 10.2169/internalmedicine.4753-20. Epub 2020 Jun 23.
Pulmonary cryptococcosis develops not only in immunocompromised patients but also in immunocompetent patients. However, lymph node involvement is relatively rare in immunocompetent patients. We herein report the case of an 80-year-old man who was not in an apparent immunocompromised state but was diagnosed with pulmonary cryptococcosis with mediastinal lymphadenopathy. The patient was resistant to fluconazole and voriconazole monotherapy; thus, his lung lesions significantly worsened. He eventually responded well to a combination therapy of amphotericin B and flucytosine, which was administered according to the treatment strategy for disseminated diseases.
肺隐球菌病不仅发生于免疫功能低下的患者,也可见于免疫功能正常的患者。然而,在免疫功能正常的患者中,淋巴结受累相对少见。本文报告了一例 80 岁男性患者,该患者无明显免疫功能低下,但被诊断为患有肺隐球菌病伴纵隔淋巴结病。该患者对氟康唑和伏立康唑单药治疗耐药,因此其肺部病变明显恶化。他最终对两性霉素 B 和氟胞嘧啶联合治疗反应良好,该治疗方案是根据播散性疾病的治疗策略制定的。