Li Xiao-Nan, Chen Jie-Hua, Lu Zhi-Wei
Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China.
Department of Respiratory, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China.
World J Clin Cases. 2025 Jun 6;13(16):100672. doi: 10.12998/wjcc.v13.i16.100672.
is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts, with diverse clinical manifestations, ranging from asymptomatic pulmonary lesions to disseminated central nervous system infections. The incidence of pulmonary cryptococcosis (PC) has rapidly increased in recent years, with an increasing proportion of non-human immunodeficiency virus-infected and immunocompetent patients making its diagnosis challenging. If not properly recognized, PC can lead to systemic dissemination and high mortality rates. Early diagnosis and treatment can improve the prognosis. This study summarizes the clinical features of three immunocompetent children with PC who presented with chest pain to raise clinicians' awareness of the disease and reduce mortality.
Three male pediatric patients in good health were hospitalized because of chest pain without cough or fever. Chest computed tomography (CT) revealed pleural-based nodules and consolidation with cavitation. A lung biopsy was performed in one case, and was cultured from the pathological tissues. was detected in the alveolar lavage fluid, and serum () polysaccharide antigen was positive in one case, and the other case was positive for serum polysaccharide. All patients received oral fluconazole treatment. Follow-up chest CT scans after six months showed significant resolution of the lesions.
PC can also occur in immunocompetent children. When encountering children with chest pain only in the clinic, one should be vigilant about PC, promptly complete the relevant examinations, and avoid misdiagnosis.
新型隐球菌是一种全身性机会致病性真菌，可在免疫功能低下和免疫功能正常的宿主中引起感染，临床表现多样，从无症状肺部病变到播散性中枢神经系统感染。近年来，肺隐球菌病（PC）的发病率迅速上升，非人类免疫缺陷病毒感染和免疫功能正常的患者比例不断增加，这使得其诊断具有挑战性。如果不能正确识别，PC可导致全身播散和高死亡率。早期诊断和治疗可改善预后。本研究总结了3例以胸痛为表现的免疫功能正常的PC患儿的临床特征，以提高临床医生对该病的认识并降低死亡率。
3例健康男性患儿因胸痛入院，无咳嗽或发热。胸部计算机断层扫描（CT）显示胸膜下结节及实变伴空洞形成。1例进行了肺活检，病理组织培养出新型隐球菌。肺泡灌洗液中检测到新型隐球菌，1例血清新型隐球菌（CrAg）多糖抗原阳性，另1例血清隐球菌多糖阳性。所有患者均接受口服氟康唑治疗。6个月后的随访胸部CT扫描显示病变明显消退。
PC也可发生于免疫功能正常的儿童。临床遇到仅有胸痛的儿童时，应警惕PC，及时完善相关检查，避免误诊。
