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Journal article
Cryptococcus neoformans Presenting as a Lung Mass in an Immunocompromised Patient
The American journal of case reports, v 23, 936968
02 Oct 2022
PMID: 36183161
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: Unusual clinical course
Background: Pulmonary cryptococcosis is an uncommon infection mainly affecting immunocompromised individuals. Presentation of cryptococcal disease ranges from asymptomatic pulmonary colonization to severe pneumonia. It can progress to acute respiratory failure and life-threatening meningoencephalitis.
Case Report: A 55-year-old woman with a history of a kidney transplant, on immunosuppressive therapy, presented to the hospital with persistent low-grade fever, headache, weight loss, and fatigue for 2 weeks. On arrival, she was tachycardic, normotensive, and saturating 99% on room air. Her chest X-ray showed right middle lung opacity measuring 1.9x2.8 cm. She was admitted and started on broad-spectrum antibiotics for suspected pneumonia. Her chest computed tomography (CT) scan showed a 3.0x1.7 cm hypo-dense opacity at the right upper lobe. Overnight, she developed a severe headache and neck stiffness. Her serum cryptococcal antigen and cerebrospinal fluid culture results were positive. The patient was started on intravenous liposomal amphotericin B plus flucytosine. A CT-guided lung biopsy was performed to rule out malignancy. Cultures came back positive for Cryptococcus neoformans. She completed a 2-week course of amphotericin and flucytosine and was switched to oral fluconazole to complete an 8-week course.
Conclusions: Prompt diagnosis and effective management of the cryptococcal disease can decrease morbidity and mortality. Diagnosis requires CT-guided lung biopsy, with culture growing mucoid colonies of Cryptococcus neoformans. Antifungal therapy with intravenous liposomal amphotericin B plus flucytosine is the mainstay of treatment. Clinicians should be aware of the various presentations of pulmonary cryptococcosis, especially in immuno-compromised patients.
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Details
- Title
- Cryptococcus neoformans Presenting as a Lung Mass in an Immunocompromised Patient
- Creators
- Siddique Qurashi - University of Pittsburgh Medical CenterTabinda Saleem - University of Pittsburgh Medical CenterIuliia Kovalenko - University of Pittsburgh Medical CenterKonstantin Golubykh - University of Pittsburgh Medical CenterLauren Holleran - Drexel University
- Publication Details
- The American journal of case reports, v 23, 936968
- Publisher
- Int Scientific Information, Inc
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000867289200001
- Scopus ID
- 2-s2.0-85139139193
- Other Identifier
- 991021861314404721
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- Web of Science research areas
- Infectious Diseases