Kurata Keiji, Nishimura Sho, Higashime Ako, Kawaguchi Koji, Nagao Shigeki, Kozuki Yoko, Sai Satoshi, Yakushijin Kimikazu, Yamamoto Katsuya, Ito Mitsuhiro, Matsuoka Hiroshi, Minami Hironobu
Department of Medical Oncology and Hematology, Kobe University Hospital, Japan.
Division of Infectious Diseases, Kobe University Hospital, Japan.
J Infect Chemother. 2020 Nov;26(11):1216-1219. doi: 10.1016/j.jiac.2020.07.004. Epub 2020 Jul 31.
Disseminated cryptococcosis, usually involving the lungs and central nervous system, carries a high risk of morbidity and mortality in immunocompromised hosts. In this report, we describe a case of miliary pulmonary cryptococcosis in a patient with acute myeloid leukemia, initially resembling miliary tuberculosis. The diagnosis of disseminated cryptococcosis was made based on transbronchial lung biopsy with subsequent detection of Cryptococcus neoformans in blood and cerebrospinal fluid. The patient was treated with liposomal amphotericin B as induction therapy, followed by fluconazole as consolidation and maintenance therapies thereafter. The infection was improved immediately, and he successfully underwent hematopoietic stem cell transplantation. The present case serves as a timely reminder that a radiological miliary pattern necessitates a thorough search for a definitive microbiological and histopathological diagnosis.
播散性隐球菌病通常累及肺部和中枢神经系统,在免疫功能低下的宿主中具有很高的发病和死亡风险。在本报告中,我们描述了一例急性髓系白血病患者发生粟粒性肺隐球菌病的病例,最初类似粟粒性肺结核。通过经支气管肺活检并随后在血液和脑脊液中检测到新型隐球菌,从而确诊为播散性隐球菌病。患者接受脂质体两性霉素B作为诱导治疗,随后使用氟康唑进行巩固和维持治疗。感染立即得到改善,并且他成功接受了造血干细胞移植。本病例及时提醒我们,影像学上的粟粒样表现需要彻底寻找明确的微生物学和组织病理学诊断。