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Allena N, Kolli M, Tale S, Soibam P, Layek A. Pulmonary Cryptococcosis Mimicking Lung Cancer: A Diagnostic Challenge. Cureus 2023; 15:e47597. [PMID: 38022362 PMCID: PMC10665769 DOI: 10.7759/cureus.47597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary cryptococcosis, although rare, maybe seen in both immunocompromised and immunocompetent patients. Cryptococcosis presenting as a lung mass mimicking lung cancer is very rare. Here, we report our experience with pulmonary cryptococcosis presenting as a lung mass mimicking malignancy in an immunocompetent patient. In this case, the patient presented to us with left-sided pleural effusion and lung mass on computed tomography (CT) of the chest. Bronchoscopy and endobronchial ultrasound (EBUS)-guided fine needle aspiration cytology (FNAC) was performed, which showed cryptococcal organisms. He responded well to oral anti-fungal therapy without any need for surgical interventions.
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Affiliation(s)
- Nishant Allena
- Department of Internal Medicine, BronxCare Health System, New York, USA
| | - Mrudula Kolli
- Department of Internal Medicine, Gayatri Vidya Parishad Medical College, Visakhapatnam, IND
| | - Sudheer Tale
- Department of Internal Medicine, Maharajah's Institute of Medical Sciences, Visakhapatnam, IND
- Department of Pulmonary and Critical Care Medicine, Medicover Hospitals, Visakhapatnam, IND
| | - Pahel Soibam
- Department of Pulmonary and Critical Care Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, IND
| | - Avishek Layek
- Department of Chest Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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2
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Zhang Y, Chu Z, Yu J, Chen X, Liu J, Xu J, Huang C, Peng L. Computed tomography-based radiomics for identifying pulmonary cryptococcosis mimicking lung cancer. Med Phys 2022; 49:5943-5952. [PMID: 35678964 DOI: 10.1002/mp.15789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) is an invasive pulmonary fungal disease, and nodule/mass-type PC may mimic lung cancer (LC) in imaging appearance. Thus, an accurate diagnosis of nodule/mass-type PC is beneficial for appropriate management. However, the differentiation of nodule/mass-type PC from LC through computed tomography (CT) is still challenging. PURPOSE To develop and externally test a CT-based radiomics model for differentiating nodule/mass-type PC from LC. METHODS In this retrospective study, patients with nodule/mass-type PC or LC who underwent non-enhanced chest CT were included: institution 1 was for the training set, and institutions 2 and 3 were for the external test set. Large quantities of radiomics features were extracted. The radiomics score (Rad-score) was calculated using the linear discriminant analysis, and a subsequent 5-fold cross-validation was performed. A combined model was developed by incorporating Rad-score and clinical factors. Finally, the models were tested with an external test set and compared using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 168 patients (45 with PC and 123 with LC) were in the training set, and 72 (36 with PC and 36 with LC) were in the external test set. Of the 81 patients with PC, 30 were immunocompromised (37%). Rad-score, comprised of 18 features, had an AUC of 0.844 after 5-fold cross-validation, which was lower than that (AUC = 0.943, P = 0.003) of the combined model integrating Rad-score, age, lobulation, pleural retraction, and patches. In the external test set, Rad-score and the combined model obtained good predictive performance (AUC = 0.824 for Rad-score, and 0.869 for the combined model). Moreover, the combined model outperformed the clinical model in the cross-validation and external test (0.943 vs. 0.810, P <0.001; 0.869 vs. 0.769, P = 0.011). CONCLUSIONS The proposed combined model exhibits a good differential diagnostic performance between nodule/mass-type PC and LC. The CT-based radiomics analysis has the potential to serve as an effective tool for the differentiation of nodule/mass-type PC from LC in clinical practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yongchang Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, China.,Department of Radiology, Chengdu Seventh People's Hospital, Chengdu, Sichuan Province, 610213, China
| | - Zhigang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Jing Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, 100080, China
| | - Chencui Huang
- Department of Research Collaboration, R&D center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, 100080, China
| | - Liqing Peng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, China
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Zhao J, Sun L, Sun K, Wang T, Wang B, Yang Y, Wu C, Sun X. Development and Validation of a Radiomics Nomogram for Differentiating Pulmonary Cryptococcosis and Lung Adenocarcinoma in Solitary Pulmonary Solid Nodule. Front Oncol 2021; 11:759840. [PMID: 34858836 PMCID: PMC8630666 DOI: 10.3389/fonc.2021.759840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/18/2021] [Indexed: 01/11/2023] Open
Abstract
Objective To establish a CT-based radiomics nomogram model for classifying pulmonary cryptococcosis (PC) and lung adenocarcinoma (LAC) in patients with a solitary pulmonary solid nodule (SPSN) and assess its differentiation ability. Materials and Methods A total of 213 patients with PC and 213 cases of LAC (matched based on age and gender) were recruited into this retrospective research with their clinical characteristics and radiological features. High-dimensional radiomics features were acquired from each mask delineated by radiologists manually. We adopted the max-relevance and min-redundancy (mRMR) approach to filter the redundant features and retained the relevant features at first. Then, we used the least absolute shrinkage and operator (LASSO) algorithms as an analysis tool to calculate the coefficients of features and remove the low-weight features. After multivariable logistic regression analysis, a radiomics nomogram model was constructed with clinical characteristics, radiological signs, and radiomics score. We calculated the performance assessment parameters, such as sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV), in various models. The receiver operating characteristic (ROC) curve analysis and the decision curve analysis (DCA) were drawn to visualize the diagnostic ability and the clinical benefit. Results We extracted 1,130 radiomics features from each CT image. The 24 most significant radiomics features in distinguishing PC and LAC were retained, and the radiomics signature was constructed through a three-step feature selection process. Three factors-maximum diameter, lobulation, and pleural retraction-were still statistically significant in multivariate analysis and incorporated into a combined model with radiomics signature to develop the predictive nomogram, which showed excellent classification ability. The area under curve (AUC) yielded 0.91 (sensitivity, 80%; specificity, 83%; accuracy, 82%; NPV, 80%; PPV, 83%) and 0.89 (sensitivity, 81%; specificity, 83%; accuracy, 82%; NPV, 81%; PPV, 82%) in training and test cohorts, respectively. The net reclassification indexes (NRIs) were greater than zero (p < 0.05). The Delong test showed a significant difference (p < 0.0001) between the AUCs from the clinical model and the nomogram. Conclusions The radiomics technology can preoperatively differentiate PC and lung adenocarcinoma. The nomogram-integrated CT findings and radiomics feature can provide more clinical benefits in solitary pulmonary solid nodule diagnosis.
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Affiliation(s)
- Jiabi Zhao
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lin Sun
- Department of Radiation Medicine, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Ke Sun
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tingting Wang
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Bhatia A, Joshi S, Tayal N, Gupta R, Kapoor N. Pulmonary cryptococcosis presenting as miliary tuberculosis in an immunocompetent patient. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2021. [DOI: 10.4103/jacp.jacp_5_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Park M, Ho DY, Wakelee HA, Neal JW. Opportunistic Invasive Fungal Infections Mimicking Progression of Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:e193-e200. [PMID: 33168426 DOI: 10.1016/j.cllc.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many studies have shown that invasive pulmonary aspergillosis, cryptococcosis, and mucormycosis can mimic radiographic and clinical features of primary lung cancer. However, more research surveying the incidence and outcomes of these fungal infections among patients with a history of lung cancer is needed. The aim of this study was to describe the occurrence and clinical outcomes of opportunistic invasive fungal infections that can mimic tumors in non-small-cell lung cancer patients. PATIENTS AND METHODS Patients seen at Stanford University Medical Center from January 1, 2007, to May 1, 2020, with pulmonary aspergillosis, cryptococcosis, or mucormycosis after non-small-cell lung cancer (NSCLC) diagnosis were reviewed. The European Organization for Research and Treatment of Cancer National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria was used to classify patients with evidence of proven or probable invasive fungal infection within our cohort. RESULTS A total of 12 patients with proven or probable invasive mold infection (including 8 cases of aspergillosis) and 1 patient with proven cryptococcosis were identified, without any cases of mucormycosis. Of this cohort, 6 patients (46%) showed radiographic findings that were found to be most consistent with lung cancer by radiologists. Eight cases (62%) were suspected of cancer recurrence or progression by the treatment team on the basis of additional considerations of medical history and clinical symptoms. Most patients had active NSCLC or had a history of recurrence without active NSCLC at the time of fungal discovery (11 patients; 85%). Most patients died without full recovery (7 patients; 54%). CONCLUSIONS Invasive pulmonary aspergillosis and cryptococcosis can often be mistaken as cancer recurrence or progression in patients with a history of NSCLC because of mimicking radiographic and clinical characteristics.
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Affiliation(s)
- Marian Park
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Dora Y Ho
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA.
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Paul M, Bhatia M, Rohilla R, Sasirekha U, Kaistha N. Cryptococcosis in non-human immunodeficiency virus-infected patients: A clinical dilemma and diagnostic enigma. Indian J Med Microbiol 2020; 38:229-234. [PMID: 32883941 DOI: 10.4103/ijmm.ijmm_20_243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cryptococcosis is a fungal disease with worldwide distribution and wide array of clinical manifestations, caused by encapsulated basidiomycetous yeasts called Cryptococcus spp. It has traditionally been considered an opportunistic infection known to occur in immunocompromised hosts, particularly those who are infected with human immunodeficiency virus. However, this infection has also been reported in phenotypically 'normal' or otherwise clinically non-immunocompromised patients. The seemingly mysterious nature of this potentially fatal illness has always kept clinicians and diagnosticians in a dilemma. This case series reiterates this perspective.
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Affiliation(s)
- Manisha Paul
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mohit Bhatia
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ranjana Rohilla
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Udayakumar Sasirekha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Adzic-Vukicevic T, Cevik M, Poluga J, Micic J, Rubino S, Paglietti B, Barac A. An exceptional case report of disseminated cryptococcosis in a hitherto immunocompetent patient. Rev Inst Med Trop Sao Paulo 2020; 62:e3. [PMID: 31967211 PMCID: PMC6968789 DOI: 10.1590/s1678-9946202062003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023] Open
Abstract
Cryptococcosis is an opportunistic fungal infection causes significant disease predominantly in immunocompromised patients. Here we present an excepcional case of disseminated cryptococcosis with pulmonary and cerebral involvement in an immunocompetent patient with no apparent predisposing factors at the time of hospital admission. We described a case of an apparently immunocompetent 66-years old man admitted to hospital with a one-month history of cough, fever and vertigo. During hospitalization, thorax imaging was suggestive of lung metastasis, therefore, he went through several investigations. During hospitalization, he developed neurological symptoms and subsequently underwent a lumbar puncture. Cerebrospinal fluid (CSF) culture was positive for Cryptococcus spp. isolated on Sabouraud's dextrose agar and bird seed agar. In addition, the direct microscopy examination was positive for the India ink test, as well as with the latex agglutination test for cryptococcal polysaccharide antigen (CrAg) in CSF, while serum CrAg was negative. Despite the absence of classic immunocompromising features, he was treated with amphotericin B and fluconazole due to suspected disseminated cryptococcal infection. Later, he was diagnosed with prostatic adenocarcinoma. Upon successful completion of treatment for disseminated cryptococcosis, the patient underwent radical prostate ablation surgery as a treatment forprostatic adenocarcinoma. This exceptional case emphasizes the high degree of suspicion of atypical infections, and in these cases, it is particularly important to consider fungal infections in hitherto healthy patients with no apparent predisposing factors. Although Cryptococcus spp. is predominantly reported in patients with hematological malignancies, cryptococcosis investigation should also be considered as part of the initial workup of patients with a new diagnosis of a solid tumour prior to chemotherapy or radiotherapy.
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Affiliation(s)
- Tatjana Adzic-Vukicevic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Muge Cevik
- University of St. Andrews, School of Medicine, St Andrews, United Kingdom
| | - Jasmina Poluga
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
| | - Jelena Micic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia
| | - Salvatore Rubino
- University of Sassari, Department of Biomedical Sciences, Sassari, Italy
| | - Bianca Paglietti
- University of Sassari, Department of Biomedical Sciences, Sassari, Italy
| | - Aleksandra Barac
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
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Huang J, Li H, Lan C, Zou S, Zhang H, Wang X, Weng H. Concomitant severe influenza and cryptococcal infections: A case report and literature review. Medicine (Baltimore) 2019; 98:e15544. [PMID: 31083210 PMCID: PMC6531193 DOI: 10.1097/md.0000000000015544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Concomitant influenza and cryptococcal infections are rare. Herein, we describe an unusual case of an avian influenza A (H7N9) infection with several severe mixed bacterial infections and systemic super-infection with Cryptococcus neoformans presenting as ventilator-associated pneumonia (VAP) and bloodstream infection in a previously immunocompetent man during hospitalization.A 58-year-old man was admitted to our hospital complaining of hyperpyrexia, dyspnoea, cough, and phlegm with blood. A chest computed tomography scan revealed multiple ground-glass opacities and consolidation in both lungs with right pleural effusion. An initial sputum test was positive for influenza A (H7N9) virus. After antiviral treatment and other supportive measures, the patient's condition improved. However, the patient's condition deteriorated again approximately 2 weeks after admission, and bronchoalveolar lavage fluid (BALF) and blood cultures were positive for C. neoformans. Therapy with intravenous liposomal amphotericin B and fluconazole was started. After a 2-week antifungal treatment, BALF and blood cultures were negative for C. neoformans. However, the patient had persistent lung infiltrates with severe pulmonary fibrosis with a prolonged course of disease. On hospital day 40, BALF and blood cultures were both positive for multidrug-resistant Stenotrophomonas maltophilia. Finally, the patient developed septic shock, disseminated intravascular coagulation and multi-organ failure and succumbed to treatment failure.Cryptococcal infection can occur in patients with severe influenza during hospitalization with a more severe condition, and the clinician should be aware of this infection.
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Affiliation(s)
- Jinbao Huang
- Department of Respiratory and Critical Care Medicine
| | - Hongyan Li
- Department of Respiratory and Critical Care Medicine
| | | | - Shenghua Zou
- Department of Clinical Laboratory, Fuzhou Pulmonary Hospital of Fujian, Educational Hospital of Fujian Medical University, Fuzhou, China
| | | | - Xinhang Wang
- Department of Respiratory and Critical Care Medicine
| | - Heng Weng
- Department of Respiratory and Critical Care Medicine
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Fisher JF, Valencia-Rey PA, Davis WB. Pulmonary Cryptococcosis in the Immunocompetent Patient-Many Questions, Some Answers. Open Forum Infect Dis 2016; 3:ofw167. [PMID: 27704021 PMCID: PMC5047412 DOI: 10.1093/ofid/ofw167] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
Background. There are no prospective data regarding the management of pulmonary cryptococcosis in the immunocompetent patient. Clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe disease. It is unclear whether patients who have histological evidence of Cryptococcus neoformans but negative cultures will even respond to drug treatment. We evaluated and managed a patient whose presentation and course raised important questions regarding the significance of negative cultures, antifungal choices, duration of therapy, and resolution of clinical, serologic, and radiographic findings. Methods. In addition to our experience, to answer these questions we reviewed available case reports and case series regarding immunocompetent patients with pulmonary cryptococcosis for the last 55 years using the following definitions: Definite - Clinical and/or radiographic findings of pulmonary infection and respiratory tract isolation of C. neoformans without other suspected etiologies; Probable - Clinical and radiographic findings of pulmonary infection, histopathologic evidence of C. neoformans, and negative fungal cultures with or without a positive cryptococcal polysaccharide antigen. Results. Pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy. Clinical, radiographic, and serologic resolution is slow and may take years. Conclusions. Persistently positive antigen titers are most common in untreated patients and may remain strongly positive despite complete or partial resolution of disease. Respiratory fungal cultures are often negative and may indicate nonviable organisms.
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Jang DW, Jeong I, Kim SJ, Kim SW, Park SY, Kwon YH, Jeong YO, Lee JY, Kim BS, Kim WS, Joh JS. Pulmonary cryptococcosis that mimicked rheumatoid nodule in rheumatoid arthritis lesion. Tuberc Respir Dis (Seoul) 2014; 77:266-70. [PMID: 25580144 PMCID: PMC4286785 DOI: 10.4046/trd.2014.77.6.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/04/2014] [Accepted: 08/28/2014] [Indexed: 11/24/2022] Open
Abstract
Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5×2.1×2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.
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Affiliation(s)
- Dong Won Jang
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ina Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seon Jae Kim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seok Won Kim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Soo Yeon Park
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yeon Oh Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ji Yeon Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Bo Sung Kim
- Department of Pathology, National Medical Center, Seoul, Korea
| | - Woo-Shik Kim
- Department of Thoracic and Cardiovascular Surgery, National Medical Center, Seoul, Korea
| | - Joon-Sung Joh
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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Matzumura-Kuan M, Jennings J. Aggregatibacter actinomycetemcomitans infection mimicking lung cancer: A case report. ACTA ACUST UNITED AC 2014; 46:669-72. [DOI: 10.3109/00365548.2014.920104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Treatment and outcomes among patients with Cryptococcus gattii infections in the United States Pacific Northwest. PLoS One 2014; 9:e88875. [PMID: 24586423 PMCID: PMC3929541 DOI: 10.1371/journal.pone.0088875] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/17/2014] [Indexed: 12/18/2022] Open
Abstract
Background Cryptococcus gattii is a fungal pathogen causing an emerging outbreak in the United States Pacific Northwest (PNW). Treatment guidelines for cryptococcosis are primarily based on data from C. neoformans infections; applicability to PNW C. gattii infection is unknown. We evaluated the relationship between initial antifungal treatment and outcomes for PNW C.gattii patients. Methods Cases were defined as culture-confirmed invasive C. gattii infections among residents of Oregon and Washington States during 2004–2011. Clinical data were abstracted from medical records through one year of follow-up. Recommended initial treatment for central nervous system (CNS), bloodstream, and severe pulmonary infections is amphotericin B and 5-flucytosine; for non-severe pulmonary infections, recommended initial treatment is fluconazole. Alternative initial treatment was defined as any other initial antifungal treatment. Results Seventy patients survived to diagnosis; 50 (71%) received the recommended initial treatment and 20 (29%) received an alternative. Fewer patients with pulmonary infections [21 (64%)] than CNS infections [25 (83%)] received the recommended initial treatment (p = 0.07). Among patients with pulmonary infections, those with severe infections received the recommended initial treatment less often than those with non-severe infections (11% vs. 83%, p<0.0001). Eight patients with severe pulmonary infections received alternative initial treatments; three died. Four patients with non-severe pulmonary infections received alternative initial treatments; two died. There was a trend towards increased three-month mortality among patients receiving alternative vs. recommended initial treatment (30% vs. 14%, p = 0.12), driven primarily by increased mortality among patients with pulmonary disease receiving alternative vs. recommended initial treatment (42% vs. 10%, p = 0.07). Conclusions C.gattii patients with pulmonary infections – especially severe infections – may be less likely to receive recommended treatment than those with CNS infections; alternative treatment may be associated with increased mortality. Reasons for receipt of alternative treatment among C.gattii patients in this area should be investigated, and clinician awareness of recommended treatment reinforced.
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Illnait-Zaragozí MT, Ortega-Gonzalez LM, Hagen F, Martínez-Machin GF, Meis JF. Fatal Cryptococcus gattii genotype AFLP5 infection in an immunocompetent Cuban patient. Med Mycol Case Rep 2013; 2:48-51. [PMID: 24432215 PMCID: PMC3885943 DOI: 10.1016/j.mmcr.2013.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 12/21/2022] Open
Abstract
We describe the first clinical case of cryptococcosis due C. gattii in a Cuban immunocompetent patient who had a traveling history two years before to Central America. Molecular characterization of the isolate showed it to be genotype AFLP5 of which MLST sequences clustered with clinical and environmental strains from Colombia. The patient died one year after the diagnosis despite a prolonged treatment with (liposomal) amphotericin B, fluconazole, voriconazole and gamma interferon.
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Affiliation(s)
| | | | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
| | | | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, PO Box 9015, Nijmegen 6500 GS, The Netherlands
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
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