Cryptococcus Pneumonia Complicating Churg-Strauss Syndrome

Abstract

Crytpococcus neoformans usually infects individuals who are HIV-infected or immunosuppressed for other reasons and clinically presents as meningoencephalitis, pneumonia or disseminated disease. We describe a 57-year-old man with history of asthma, allergic rhinosinusitis, nasal polyps and chronic receipt of low dose steroids who presented to the emergency department with fever, dry cough, respiratory distress and hematuria. His laboratory studies showed leukocytosis and eosinophilia with a negative HIV antibody test. CT scan of the chest showed right lower lobe patchy opacities. The patient deteriorated during hospitalization, developed hemoptysis and hypoxia, and was electively intubated. Repeat CT scan of the chest showed diffuse alveolar and interstitial opacities with mediastinal lymphadenopathy. The cytoplasmic anti-neutrophil cytoplasmic antibody (C-ANCA) was markedly elevated and the patient was diagnosed with Churg-Strauss Syndrome (CSS). Culture of bronchoalveolar lavage fluid yielded growth of Cryptococcus neoformans . The patient responded well to treatment with cyclophosphamide, corticosteroids, plasmapharesis and fluconazole. This case highlights the possibility that Cryptococcus neoformans can either infect or colonize patients who are immunosuppressed, including those with CSS. doi: http://dx.doi.org/10.4021/jmc755w