Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Cryptococcosis with Mediastinal Lymph Node and Lung Involvement in an Immunocompetent Adolescent: A Case Report

정상 면역체계를 가진 청소년에서 발생한 종격동 림프절과 폐 크립토코쿠스증 1예

  • Lee, Jiyeon (Department of Pediatrics, Ewha Womans University Mokdong Hospital) ;
  • Cho, Chang-Min (Department of Pediatrics, Ewha Womans University Mokdong Hospital) ;
  • Cho, Hyun-Hae (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Park, Heae Surng (Department of Pathology, Ewha Womans University Seoul Hospital) ;
  • Kim, Kyung-Hyo (Department of Pediatrics, Ewha Womans University Mokdong Hospital)
  • 이지연 (이화여자대학교 목동병원 소아청소년과) ;
  • 조창민 (이화여자대학교 목동병원 소아청소년과) ;
  • 조현혜 (이화여자대학교 목동병원 영상의학과) ;
  • 박혜성 (이화여자대학교 서울병원 병리과) ;
  • 김경효 (이화여자대학교 목동병원 소아청소년과)
  • Received : 2021.01.21
  • Accepted : 2021.07.27
  • Published : 2021.08.25
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Abstract

Cryptococcus neoformans is a fungus that primarily causes opportunistic infections in immunocompromised hosts. It can also cause various infections in immunocompetent patients. Pulmonary cryptococcosis involving the lymph node is relatively rare in immunocompetent patients. In this report, a previously healthy 17-year-old girl presented with high-grade fever and persistent cough. Chest X-ray and computed tomography (CT) scan revealed an anterior mediastinal conglomerate mass that expanded to the right supraclavicular area. Ultrasound-guided gun biopsy revealed histological evidence of cryptococcosis. Immunological screening tests did not identify immunodeficiency. She recovered completely with a combination therapy of amphotericin B and flucytosine for 2 weeks, followed by fluconazole for 8 months. The characteristics of cryptococcosis involving the mediastinal lymph node and the lung should be understood, and the possibility of cryptococcosis even in immunocompetent hosts should be considered.

Cryptococcus neoformans는 주로 면역이 저하된 환자에서 기회 감염을 일으키는 진균이다. 그러나 면역이 정상인 환자에서도 다양한 감염을 일으킬 수 있다. 림프절을 침범한 폐 크립토코쿠스증은 정상 면역을 가진 사람에서는 상대적으로 드물게 발생한다. 고열과 지속적인 기침을 주소로 병원에 온 17세 여자 청소년이 가슴X선 영상검사 및 컴퓨터단층촬영에서 전방 종격동에서 우측 쇄골하 부위까지 침범된 종괴를 보여 초음파 유도하 총생검 검사로 크립토코쿠스증을 진단하였다. 각종 면역 검사에서는 이상 소견이 발견되지 않았다. 환자는 2주간 암포테리신 B와 플루시토신으로 치료 후 8개월간 플루코나졸로 치료하였고 완쾌되었다. 본 증례를 통해 크립토코쿠스증의 특징을 이해하고 정상 면역 환자에게서도 크립토코쿠스증이 발생할 수 있음을 염두에 두고 진단을 내리는 것이 바람직하겠다.

Keywords

References

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