Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
Infectious Diseases, Charlotte Hungerford Hospital, Torrington, Connecticut, USA.
BMJ Case Rep. 2022 Mar 29;15(3):e247495. doi: 10.1136/bcr-2021-247495.
An immunocompetent man presented with disease manifesting as a large pulmonary mass (cryptococcoma). Despite an initial induction course of 4 weeks of liposomal amphotericin B (LAmB), followed by 8 weeks of fluconazole, the cryptococcoma enlarged in size. Ten days into a second course of induction therapy with LAmB and flucytosine, the cryptococcoma markedly increased in size with encroachment on critical vascular structures. Due to concern for immune reconstitution inflammatory syndrome (IRIS), prednisone was added with significant decrease in the size of the mass. To our knowledge, this is the first reported case of pulmonary cryptococcal-IRIS in an immunocompetent host.
一名免疫功能正常的男性出现了疾病表现，肺部有一个大肿块（隐球菌瘤）。尽管最初进行了 4 周的脂质体两性霉素 B（LAmB）诱导治疗，随后又进行了 8 周的氟康唑治疗，但隐球菌瘤的大小仍在增大。在第二次使用 LAmB 和氟胞嘧啶进行诱导治疗的第 10 天，隐球菌瘤明显增大，并侵犯了关键的血管结构。由于担心免疫重建炎症综合征（IRIS），加用了泼尼松，肿块大小明显缩小。据我们所知，这是首例在免疫功能正常的宿主中发生的肺部隐球菌-IRIS 病例。
