• Journal of Medicine and Life Science
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• v.19 no.1
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• pp.26-29
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• 2022

Cryptococcus neoformans infection usually occurs in patients with advanced human immunodeficiency virus (HIV) infection or with a CD4 T lymphocyte count of <100 cells/µL. Pulmonary and central nervous system infections are the most frequently encountered forms of cryptococcosis; however, colonic cryptococcosis is uncommon. We describe the case of a 41-year-old antiretroviral-naïve man with HIV infection diagnosed eight years prior and intermittent diarrhea for 4 months who presented to the emergency department with a 1-day history of low-grade fever and confusion. Brain magnetic resonance imaging and cerebrospinal fluid analysis revealed normal results; however, he was diagnosed with Pneumocystis jirovecii pneumonia based on chest computed tomography and bronchoalveolar lavage analysis. Trimethoprim-sulfamethoxazole administration was initiated followed by antiretroviral treatment. Although his condition gradually improved, he developed fever and abdominal discomfort, and the diarrhea worsened. Endoscopy revealed a small ulcer in the distal transverse colon. Histopathological examination of a colon tissue sample revealed cryptococcal infection. He improved substantially during liposomal amphotericin B and fluconazole treatment. We encountered a rare case of colonic cryptococcosis that caused chronic diarrhea in a patient with advanced HIV infection. Colonic cryptococcosis should be considered when patients with acquired immune deficiency syndrome present with gastrointestinal symptoms.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.527-531
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• 2008

Although disseminated cryptococcosis occurs most commonly in immunocompromised patients, particularly those with a human immunodeficiency virus (HIV) infection, it can occur in immune competent persons. There are no case reports of disseminated cutaneous crytpcoccosis associated with pulmonary tuberculosis in Korea. A 71-year-old female presented with fever and multiple cutaneous nodules. She was finally diagnosed with disseminated cutaneous cryptococcosis accompanied by pulmonary tuberculosis, and was treated successfully with anti-tuberculous medication and fluconazole. She had no apparent predisposing conditions for systemic cryptococcosis. We report this case with a review of the relevant literature.

• The Korean Journal of Cytopathology
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• v.4 no.2
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• pp.156-159
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• 1993

Cryptococcosis is a systemic mycosis that most often involves the central nervous system, followed by subclinical or symptomatic pulmonary involvement. We describe a case of unsuspected pulmonary cryptococcosis in a 69-year-old woman, diagnosed by sputum cytology. Sputum smears revealed numerous yeast like organisms typical of Cryptococcus neoformans measuring from 7 to 17 um in diameter. Mucicarmine, PAS, and methenamine sliver stains showed positive reaction of capsule and cell wall of Cryptococcus neoformans.

• Tuberculosis and Respiratory Diseases
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• v.73 no.3
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• pp.182-186
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• 2012

Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.

• Pediatric Infection and Vaccine
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• v.28 no.2
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• pp.124-131
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• 2021

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.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.292-296
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• 2004

Cryptococcus neoformans is a ubiquitous fungus found worldwide, particularly in soil contaminated by pigeon drop- pings. Pulmonary cryptococcosis occurs rarely in immunocompetent individuals. The risk of cryptococcal infection increases with the degree of immunal compromise, in human immunodeficiency virus infection especially. Pulmonary cryptococcosis is most frequently encountered as asymptomatic single or multiple pulmonary nodules found by routine chest x-ray examination. The diagnosis is most often made in these situations by the histology of the resected lesion. Acute progressive pneumonia may occur, with symptoms of cough, sputum production, fever, and weakness. The clinical picture is not pathognomonic. The yeasts are stained well by any of the special stains for fungi. Treatment is now indicated for all cases given a diagnosis of cryptococcosis, even if the diagnosis has been made by resecton of a solitary, asymptomatic pulmonary nodule.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.123-126
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• 2009

Cryptococcosis is a subacute or chronic inflammation that's caused by infection from cryptococcus neoformans in the soil or dust that's contaminated by pigeon droppings. Pulmonary cryptococcosis occurs in immunocompromised patients, and particularly in HIV positive patients, but it rarely occurs in immunocompetent individuals. It is most often detected as asymptomatic single or multiple nodules that are found by chest X-ray examination. In these situations, the diagnosis for most cases is made by the histology of the resected lesion. We report here on a case of solitary nodular pulmonary cryptococcosis that occurred in a 32 years old female patient who underwent thyroidectomy for treating her thyroid cancer.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.93-98
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• 1995

Cryptococcosis is a systemic infection caused by the yeast-like fungus Cryptococcus neoformans. Respiratory tract is the usual portal of infection but relatively few cases of pulmonary cryptococcosis have been reported. Recently the incidence of the disease are increasing because the perception to seek the disease is increasing and immunocompromised hosts are more widespread with introduction of immune-suppressants, steroids and advent of AIDS. Because of nonspecific pattern of clinical manifestation, radiologic findings, differentiating the other diseases is essential and it needs fungal culture and biopsy. We describe a patient in the state of bilateral adrenalectomy due to bilateral ACTH-independent macronodular hyperplasia who developed pulmonary cryptococcosis and was later infected with pulmonary tuberculosis.

• Journal of Yeungnam Medical Science
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• v.21 no.1
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• pp.74-81
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• 2004

Purpose: To evaluate the computed tomography (CT) findings of pulmonary cryptococcosis in immunocompetent patients. Materials and Methods: CT scans of 25 patients with biopsy-proven cryptococcosis [surgery (n=3), percutaneous needle biopsy (n=21), and bronchoscopic biopsy (n=1)] were analyzed. Thirteen patients were men and 12 patients were women, with a mean age of 53.7 years. Presenting symptoms were cough, sputum, and dyspnea and 12 patients presented with incidentally found chest radiographic abnormalities. Results: Nodule or multiple conglomerate nodules (n=10, 40%) and segmental or lobular consolidation (n=9, 36%) were most common, followed by mixed patterns (n=5, 20%). Predilection sites were lower lobe (n=21/37, 57%) and subpleural areas (n=23, 92%). Air bronchograms within consolidations (n=11/14, 79%) with mild volume loss (n=10/14, 71%) were common. While interlobular septal thickening (n=11, 44%) and cavitation or central low-attenuations (n=11, 44%) were relatively common, lymphadenopathy (n=2, 8%) or free pleural effusions (n=1, 4%) were uncommon. Conclusion: Nodules or airspace consolidation with a predilection of lower lobe and subpleural area are the most common appearances of pulmonary cryptococcosis in immunocompetent patients.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1083-1093
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• 1997

Background : So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. Method : The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. Results : Cryptococcosis occurred frequently over sixth decade and the male to female ratio was 3.6 : 1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnasis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case. and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture, serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. Conclusion : Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnosic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.