PDF(Pubmed)
Abstract：
Cryptococcosis is a fungal infection caused by species of the Cryptococcus genus which are commonly found in soil contaminated with bird feces, decaying wood, and tree hollows. It is usually seen in immunocompromised patients such as those with AIDS, with hematological malignancy, on immunosuppressive therapy, or after organ transplantation, and rare in immunocompetent hosts. The primary site of infection is usually the lung and the infection starts after inhalation of the pathogen and depending upon the host\'s immune response shows a different pattern of infection. Here we present a case report of a female in her late forties, who presented with two weeks of rash in her bilateral upper extremity, lower extremity, chest, and back along with arthralgia, myalgia, and proximal lower extremity weakness. Initial laboratory workup showed leukocytosis, elevated erythrocyte sedimentation rate, C-reactive protein, serum ferritin, and serum aldolase level with normal creatinine kinase. Rheumatological workups including ANA, ANCA, RF, C3, and C4 were normal. Magnetic resonance imaging of the right femur showed hyperintensity of the thigh and proximal calf musculature suggestive of muscle edema. A punch biopsy from the rash showed dyskeratosis with mild perivascular neutrophilic infiltrate. Steroid therapy and rituximab were started with some improvement. However, the patient developed respiratory distress and diffuse alveolar hemorrhage. Bronchoscopy was done and bronchoalveolar lavage fluid grew Serratia and Candida. The patient improved with antibiotic and antifungal therapy. However, the patient again developed respiratory distress and a new diffuse alveolar hemorrhage. A repeat bronchoscopy was done and the new bronchoalveolar lavage grew Cryptococcus neoformans. Blood cultures also grew Cryptococcus neoformans. The patient was started on amphotericin B and flucytosine. The patient initially improved and was transferred to the rehabilitation unit but ultimately her course was complicated by multiple infections and intubations and she unfortunately passed away.
摘要：
隐球菌病是由隐球菌属引起的真菌感染，通常在被鸟粪污染的土壤中发现，腐烂的木材，和树洞。它通常见于免疫功能低下的患者，如艾滋病患者，患有血液系统恶性肿瘤，关于免疫抑制治疗，或器官移植后，在免疫能力强的宿主中很少见。感染的主要部位通常是肺部，感染在吸入病原体后开始，根据宿主的免疫反应显示出不同的感染模式。在这里，我们提供了一个四十多岁的女性病例报告，她的双侧上肢出现了两周的皮疹，下肢,胸部，伴随着关节痛，肌痛，和下肢近端无力。最初的实验室检查显示白细胞增多，红细胞沉降率升高，C反应蛋白,血清铁蛋白,血清醛缩酶水平与肌酐激酶正常。风湿病检查，包括ANA，ANCA,射频,C3和C4均正常。右股骨的磁共振成像显示大腿和小腿近端肌肉组织的高强度，提示肌肉水肿。皮疹的穿刺活检显示角化不良伴轻度血管周围嗜中性粒细胞浸润。类固醇治疗和利妥昔单抗开始有一些改善。然而,患者出现呼吸窘迫和弥漫性肺泡出血。进行支气管镜检查，支气管肺泡灌洗液生长沙雷氏菌和念珠菌。患者通过抗生素和抗真菌治疗得到改善。然而,患者再次出现呼吸窘迫和新的弥漫性肺泡出血。进行了重复的支气管镜检查，新的支气管肺泡灌洗产生了新生隐球菌。血液培养也生长了新生隐球菌。患者开始服用两性霉素B和氟胞嘧啶。患者最初有所改善，并被转移到康复中心，但最终她的病程因多次感染和插管而变得复杂，不幸去世。
