[Disseminated Cryptococcosis with Eosinophilia and Elevated IgE in a Non-HIV-infected Patient]

Kansenshogaku Zasshi. 2016 Nov;90(6):819-24.
[Article in Japanese]

Abstract

In general, disseminated cryptococcosis usually occurs among immunocompromised patients, especially those with cell-mediated immunodeficiency, such as HIV-infected patients. We present herein a rare case of an apparently immunocompetent 33-year-old woman who developed disseminated cryptococcal diseases, which included meningitis and pneumonia with eosinophilia, and pulmonary tuberculosis during her disease course. Pneumonia with a diffuse micronodular pattern, immediately followed by meningitis, was diagnosed as disseminated cryptococcosis, because of the presence of yeast-like-fungi demonstrated by transbronchial lung biopsy and a positive cerebrospinal fluid (CSF) culture. In addition, the pneumonia exhibited eosinophilia in the peripheral blood and bronchoalveolar lavage fluid. Re-exacerbation of the pneumonia occurred approximately 3 weeks after onset, along with a sputum culture positive for Mycobacterium tuberculosis. Administration of anti-tuberculosis drugs resulted in recovery from the pulmonary tuberculosis. The treatment of cryptococcal meningitis was initiated using a standard induction regimen;however, an unrecovered status, highlighted by elevated CSF pressure, persisted. Finally, full recovery was induced by the addition of flucytosine treatment (100 mg/kg/day) and repeated daily via lumbar puncture. The allergic condition of this patient may have contributed to the onset of disseminated cryptococcosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cryptococcosis / complications*
  • Cryptococcosis / therapy
  • Drug Combinations
  • Eosinophilia / complications*
  • Eosinophilia / immunology*
  • Female
  • HIV Infections
  • Humans
  • Immunoglobulin E / immunology*
  • Mycobacterium tuberculosis / isolation & purification

Substances

  • Drug Combinations
  • Immunoglobulin E