Abstract
A 73-year-old man visited Kawasaki Medical School Hospital with complaints of cough and fever persisting for five days. He was diagnosed with myasthenia gravis in 2010 and had received immunosuppressive treatment for eight years. He presented with infiltration shadows in the bilateral middle and lower lung fields. Because both influenza A virus antigen and urinary pneumococcal pneumonia antigen were positive in laboratory findings, he was diagnosed with pneumococcal pneumonia co-infection with influenza a on admission. We administered peramivir and sulbactam/ampicillin after admission. Although the inflammatory response improved, infiltration shadows did not improve. We performed bronchoscopic examination and obtained the diagnosis of the complication of pulmonary cryptococcosis by transbronchial lung biopsy. He was treated with fluconazole for six months for pulmonary cryptococcosis and he showed improvement without adverse reactions. We report an interesting immunocompromised patient with pulmonary cryptococcosis complicated by pneumococcal pneumonia co-infection with influenza A.
Highlights
BackgroundPulmonary cryptococcosis is a fungal respiratory infection that occurs after the inhalation of Cryptococcus spp
Because positive responses of influenza A virus antigen and urinary pneumococcal antigen were recognized in the laboratory findings on admission, we delayed the diagnosis of pulmonary cryptococcosis in this case
Because our patient received long-term immunosuppressive treatment and had pulmonary cryptococcosis, and complicated pneumococcal pneumonia co-infection with influenza a virus, we think that the histological findings showed an atypical pattern such as organizing pneumonia with masson bodies, without forming a granuloma and noted cryptococcus within masson bodies
Summary
Pulmonary cryptococcosis is a fungal respiratory infection that occurs after the inhalation of Cryptococcus spp. Regarding the radiological findings on admission, chest X-ray showed infiltration shadows in the bilateral middle and lower ling fields (Fig. 1). Chest Computed Tomography (CT) on admission revealed infiltration shadows with an air-bronchogram and ground-glass opacity with peripheral zone dominance in both lung fields (Fig. 2a and 2b). We diagnosed this patient with pneumococcal pneumonia co-infection with influenza A virus. The smear and culture examinations of common bacteria, fungus and acid-fast bacilli of brushing and Bronchoalveolar Lavage Fluid (BALF) from right middle and lower lobes were all negative, but histological findings showed organizing pneumonia with masson bodies (Fig. 3a) on Hematoxylin-Eosin (HE) staining and Cryptococcus was recognized in the masson bodies in Grocott staining (Fig. 3b). Chest X-ray (Fig. 4a and 5b) and Chest CT (Fig. 4b and 5a) showed the improvement of infiltration shadows after six months
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