Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
World J Gastroenterol. 2023 Jan 28;29(4):758-765. doi: 10.3748/wjg.v29.i4.758.
Corticosteroids and anti-tumor necrosis factor α mAbs are widely used to treat Crohn's disease (CD). However, one disadvantage of this treatment is impairment of normal immune function, leading to an increased risk of infection. Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.
Here, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment. The patients presented with no or mild respiratory symptoms. Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes. Diagnoses were made using pathological examination and metagenomic sequencing. The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo, and symptoms were resolved. Literature searches were conducted in PubMed, Web of Science, and Embase to retrieve previously reported cases and summarize patient characteristics.
The incidence of cryptococcus infection has increased along with immunomodulator use. Clinical vigilance is required for early identification and standardized treatment.
皮质类固醇和抗肿瘤坏死因子 α mAb 被广泛用于治疗克罗恩病（CD）。然而，这种治疗的一个缺点是损害正常的免疫功能，导致感染风险增加。隐球菌感染是一种机会性感染，主要发生在免疫功能低下的患者中，在 CD 患者中构成重大诊断挑战。
在此，我们报告了 3 例接受免疫调节治疗后发生肺部隐球菌病的 CD 患者。这些患者表现出无或轻度的呼吸道症状。胸部计算机断层扫描显示单侧或双侧肺叶的肺结节。通过病理检查和宏基因组测序进行诊断。患者接受氟康唑 400mg 每日一次治疗 1 至 6 个月，症状得到缓解。在 PubMed、Web of Science 和 Embase 中进行文献检索，以检索先前报道的病例并总结患者特征。
随着免疫调节剂的使用，隐球菌感染的发生率有所增加。需要保持临床警惕，以便早期识别和规范化治疗。
