Medicine, University of Toronto, Toronto, Ontario, Canada.
Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada.
BMJ Case Rep. 2023 Nov 22;16(11):e256255. doi: 10.1136/bcr-2023-256255.
is a ubiquitous environmental organism found worldwide. Infection with this organism occurs predominantly in immunocompromised hosts, including persons living with HIV or those with impaired cellular immunity. Cryptococcal pleural effusions have been described in cases with extensive pulmonary involvement. Here we present the case of a woman receiving temozolomide and steroids for glioblastoma multiforme, who developed cough and dyspnoea and was found to have an uncomplicated pleural effusion. Pleural fluid culture grew with negative culture on bronchoalveolar lavage. High serum cryptococcal antigen titre of 1:64 prompted lumbar puncture which demonstrated positive cerebrospinal fluid for She was treated with liposomal amphotericin B and flucytosine, followed by consolidation and maintenance therapy with fluconazole. Pleural involvement in the absence of pulmonary involvement has rarely been reported. We review pulmonary and radiographic manifestations of cryptococcal infection, when to assess for disseminated infection, and management principles.
隐球菌是一种普遍存在于环境中的生物体，在全球范围内均可发现。这种生物体的感染主要发生在免疫功能低下的宿主中，包括 HIV 感染者或细胞免疫受损者。已有广泛肺部受累病例中出现隐球菌性胸腔积液的描述。在此，我们报告了 1 例接受替莫唑胺和类固醇治疗多形性胶质母细胞瘤的女性，她出现咳嗽和呼吸困难，被发现有单纯性胸腔积液。胸腔积液培养出，支气管肺泡灌洗培养为阴性。血清隐球菌抗原滴度高，为 1:64，提示行腰椎穿刺，显示脑脊液为阳性。她接受了脂质体两性霉素 B 和氟胞嘧啶治疗，随后用氟康唑进行巩固和维持治疗。在没有肺部受累的情况下出现胸腔受累的情况很少见。我们回顾了隐球菌感染的肺部和影像学表现、何时评估播散性感染以及治疗原则。
