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免疫功能低下患者肺部播散性隐球菌感染表现为弥漫性空洞性结节:病例报告。

Disseminated cryptococcal infection with pulmonary involvement presenting as diffuse cavitary nodules in an immunocompromised patient: a case report.

机构信息

Department of Respiratory Medicine, People's Hospital, Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China.

Department of Critical Care Medicine, People's Hospital, Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China.

出版信息

BMC Pulm Med. 2023 Jan 27;23(1):38. doi: 10.1186/s12890-023-02332-8.

Abstract

BACKGROUND

Disseminated cryptococcal infection is especially prone to occur in immunosuppressed hosts. We herein report the case of an immunosuppressed girl with disseminated cryptococcal infection in whom pulmonary cryptococcosis (PC) presented as diffuse cavitary pulmonary nodules, a finding which has rarely been reported.

CASE PRESENTATION

A 16-year-old immunocompromised girl presented with fever and a non-productive cough. A chest computed tomography (CT) scan revealed diffuse pulmonary nodules with cavities. Subsequent results were consistent with disseminated cryptococcosis with Cryptococcus identified in her blood, bone marrow and cerebrospinal fluid cultures. Thus, the patient was diagnosed with disseminated cryptococcal infection with PC, cryptococcus meningitis, cryptococcus osteomyelitis and cryptococcus sepsis. After antifungal treatment, the patient demonstrated both clinical and chest radiological improvement.

CONCLUSION

The atypical clinical manifestations of a disseminated cryptococcal infection and the rare manner of chest CT findings of PC reported in our case are easy to misdiagnose. It is necessary to carry out a thorough search for a definitive diagnosis using various methods.

摘要

背景

播散性隐球菌感染尤其容易发生在免疫抑制宿主中。我们在此报告一例免疫抑制女孩患有播散性隐球菌感染,其肺部隐球菌病(PC)表现为弥漫性空洞性肺结节,这一发现很少有报道。

病例介绍

一名 16 岁免疫功能低下的女孩出现发热和无痰性咳嗽。胸部计算机断层扫描(CT)显示弥漫性肺结节伴空洞。随后的结果与播散性隐球菌病一致,血液、骨髓和脑脊液培养均发现隐球菌。因此,该患者被诊断为播散性隐球菌感染合并 PC、隐球菌性脑膜炎、隐球菌性骨髓炎和隐球菌性败血症。经过抗真菌治疗,患者的临床和胸部影像学均得到改善。

结论

本例患者播散性隐球菌感染的不典型临床表现和 PC 的罕见胸部 CT 表现容易误诊,需要通过多种方法进行彻底检查以明确诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ab5/9883961/086ced28149a/12890_2023_2332_Fig1_HTML.jpg

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