BACKGROUND Cryptococcus is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts,with diverse clinical manifestations,ranging from asymptomatic pulmon...BACKGROUND Cryptococcus is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts,with diverse clinical manifestations,ranging from asymptomatic pulmonary lesions to disseminated central nervous system infections.The incidence of pulmonary cryptococcosis(PC)has rapidly increased in recent years,with an increasing proportion of non-human immunodeficiency virus-infected and immunocompetent patients making its diagnosis challenging.If not properly recognized,PC can lead to systemic dissemination and high mortality rates.Early diagnosis and treatment can improve the prognosis.This study summarizes the clinical features of three immunocompetent children with PC who presented with chest pain to raise clinicians'awareness of the disease and reduce mortality.CASE SUMMARY Three male pediatric patients in good health were hospitalized because of chest pain without cough or fever.Chest computed tomography(CT)revealed pleuralbased nodules and consolidation with cavitation.A lung biopsy was performed in one case,and Cryptococcus was cultured from the pathological tissues.Cryptococcus was detected in the alveolar lavage fluid,and serum Cryptococcus capsular(C.capsular)polysaccharide antigen was positive in one case,and the other case was positive for serum C.capsular polysaccharide.All patients received oral fluconazole treatment.Follow-up chest CT scans after six months showed significant resolution of the lesions.CONCLUSION PC can also occur in immunocompetent children.When encountering children with chest pain only in the clinic,one should be vigilant about PC,promptly complete the relevant examinations,and avoid misdiagnosis.展开更多
BACKGROUND Corticosteroids and anti-tumor necrosis factorαmAbs are widely used to treat Crohn's disease(CD).However,one disadvantage of this treatment is impairment of normal immune function,leading to an increas...BACKGROUND Corticosteroids and anti-tumor necrosis factorαmAbs are widely used to treat Crohn's disease(CD).However,one disadvantage of this treatment is impairment of normal immune function,leading to an increased risk of infection.Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.CASE SUMMARY Here,we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment.The patients presented with no or mild respiratory symptoms.Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes.Diagnoses were made using pathological examination and metagenomic sequencing.The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo,and symptoms were resolved.Literature searches were conducted in PubMed,Web of Science,and Embase to retrieve previously reported cases and summarize patient characteristics.CONCLUSION The incidence of cryptococcus infection has increased along with immunomodulator use.Clinical vigilance is required for early identification and standardized treatment.展开更多
BACKGROUND Pulmonary cryptococcosis (PC) is an invasive fungal disease caused mainly byCryptococcus (C.) neoformans or C. gattii. It may be present in immunocompetent orimmunocompromised patients. The radiographic fea...BACKGROUND Pulmonary cryptococcosis (PC) is an invasive fungal disease caused mainly byCryptococcus (C.) neoformans or C. gattii. It may be present in immunocompetent orimmunocompromised patients. The radiographic features of PC vary, and themost common computed tomography manifestation is the presence of solitary ormultiple pulmonary nodules or masses distributed in the outer zone of the lungfield. The appearance of nodular or mass-like PC on computed tomography scansresembles that of primary or metastatic lung cancers, and differential diagnosis issometimes difficult. The coexistence of PC and malignant tumors is rarelyobserved.CASE SUMMARY This paper reports three cases of PC combined with lung adenocarcinomadiagnosed by video-assisted thoracic surgery lung biopsy, which weresuccessfully managed by early diagnosis and treatment.CONCLUSION The present case report might serve as a reminder not to neglect PC coexistingwith adenocarcinoma. Early diagnosis and treatment lead to a better prognosis.展开更多
BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lav...BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lavage fluid),and cryptococcal antigen(CrAg)testing are helpful for a definitive diagnosis.However,these tests are sometimes falsely negative.PC is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms,poor imaging specificity,and false-negative laboratory tests.CASE SUMMARY We report two female patients who underwent computed tomography-guided percutaneous needle pulmonary biopsy of a lung nodule for a confirmed diagnosis.In both patients,the CrAg test on the lung biopsy tissue homogenate was positive,while the serum CrAg test was negative.Combined with the lung tissue pathology,we made the diagnosis of PC.Antifungal therapy was effective in both patients.CONCLUSION Given the findings of our cases and the literature review,lung tissue homogenate CrAg testing can be helpful in improving the diagnosis of PC.展开更多
Background： Serum cryptococcal antigen （CrAg） test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this...Background： Serum cryptococcal antigen （CrAg） test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus （HIV） adult patients with pulmonary cryptococcosis and its clinical features. Methods： One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive （CrAg＋ group） and 29 were negative （CrAg- group）. It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio （OR） was used to measure correlation. Student＇s t-test was obtained to analyze continuous variable. Results： No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups （P 〉 0.05 in all）. Nevertheless, diffuse extent lesion was 82.1% in CrAg＋ group and 10.3% in CrAg- group （χ2 = 40.34, P〈 0.001; OR = 39.87）. Conclusions： Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.展开更多
THE causes of Cushing＇s syndrome are mainly di- vided into adrenocorticotropic hormone （ACTH） dependent and independent. ACTH dependent hypercortisolism represents excess ACTH se-creting by the pituitary or tumor o...THE causes of Cushing＇s syndrome are mainly di- vided into adrenocorticotropic hormone （ACTH） dependent and independent. ACTH dependent hypercortisolism represents excess ACTH se-creting by the pituitary or tumor outside the pituitary; and the latter one is also called as ectopic ACTH syndrome. Thorax is the most common location of causative lesions for ectopic ACTH syndrome, and the size of lesion is too small to be detected in some cases.1＇ 2 Cryptococcal pneumonia usually occurs in immunocompromised patients and excess cortisol production can theoretically produce a state of immunodeficiency. Development of cryptococcal pneumonia concomitant with Cushing syndrome （CS） was rare. Here, we report a case of pulmonary nodule in a patient with CS differentiated with ectopic ACTH-producing tumor. Crypto- coccal pneumonia was diagnosed followinglung resection.展开更多
基金Supported by Shenzhen Fund for Guangdong Provincial High-Level Clinical Key Specialties,No.SZGSP012Shenzhen Key Medical Discipline Construction Fund,No.SZXK032。
文摘BACKGROUND Cryptococcus is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts,with diverse clinical manifestations,ranging from asymptomatic pulmonary lesions to disseminated central nervous system infections.The incidence of pulmonary cryptococcosis(PC)has rapidly increased in recent years,with an increasing proportion of non-human immunodeficiency virus-infected and immunocompetent patients making its diagnosis challenging.If not properly recognized,PC can lead to systemic dissemination and high mortality rates.Early diagnosis and treatment can improve the prognosis.This study summarizes the clinical features of three immunocompetent children with PC who presented with chest pain to raise clinicians'awareness of the disease and reduce mortality.CASE SUMMARY Three male pediatric patients in good health were hospitalized because of chest pain without cough or fever.Chest computed tomography(CT)revealed pleuralbased nodules and consolidation with cavitation.A lung biopsy was performed in one case,and Cryptococcus was cultured from the pathological tissues.Cryptococcus was detected in the alveolar lavage fluid,and serum Cryptococcus capsular(C.capsular)polysaccharide antigen was positive in one case,and the other case was positive for serum C.capsular polysaccharide.All patients received oral fluconazole treatment.Follow-up chest CT scans after six months showed significant resolution of the lesions.CONCLUSION PC can also occur in immunocompetent children.When encountering children with chest pain only in the clinic,one should be vigilant about PC,promptly complete the relevant examinations,and avoid misdiagnosis.
文摘BACKGROUND Corticosteroids and anti-tumor necrosis factorαmAbs are widely used to treat Crohn's disease(CD).However,one disadvantage of this treatment is impairment of normal immune function,leading to an increased risk of infection.Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.CASE SUMMARY Here,we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment.The patients presented with no or mild respiratory symptoms.Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes.Diagnoses were made using pathological examination and metagenomic sequencing.The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo,and symptoms were resolved.Literature searches were conducted in PubMed,Web of Science,and Embase to retrieve previously reported cases and summarize patient characteristics.CONCLUSION The incidence of cryptococcus infection has increased along with immunomodulator use.Clinical vigilance is required for early identification and standardized treatment.
文摘BACKGROUND Pulmonary cryptococcosis (PC) is an invasive fungal disease caused mainly byCryptococcus (C.) neoformans or C. gattii. It may be present in immunocompetent orimmunocompromised patients. The radiographic features of PC vary, and themost common computed tomography manifestation is the presence of solitary ormultiple pulmonary nodules or masses distributed in the outer zone of the lungfield. The appearance of nodular or mass-like PC on computed tomography scansresembles that of primary or metastatic lung cancers, and differential diagnosis issometimes difficult. The coexistence of PC and malignant tumors is rarelyobserved.CASE SUMMARY This paper reports three cases of PC combined with lung adenocarcinomadiagnosed by video-assisted thoracic surgery lung biopsy, which weresuccessfully managed by early diagnosis and treatment.CONCLUSION The present case report might serve as a reminder not to neglect PC coexistingwith adenocarcinoma. Early diagnosis and treatment lead to a better prognosis.
文摘BACKGROUND Pulmonary cryptococcosis(PC)is an opportunistic infectious disease of the respiratory system.Lung tissue biopsies,culture of respiratory samples(e.g.,sputum,lung tissue,pleural fluid,and bronchoalveolar lavage fluid),and cryptococcal antigen(CrAg)testing are helpful for a definitive diagnosis.However,these tests are sometimes falsely negative.PC is often misdiagnosed or underdiagnosed owing to the absence of obvert symptoms,poor imaging specificity,and false-negative laboratory tests.CASE SUMMARY We report two female patients who underwent computed tomography-guided percutaneous needle pulmonary biopsy of a lung nodule for a confirmed diagnosis.In both patients,the CrAg test on the lung biopsy tissue homogenate was positive,while the serum CrAg test was negative.Combined with the lung tissue pathology,we made the diagnosis of PC.Antifungal therapy was effective in both patients.CONCLUSION Given the findings of our cases and the literature review,lung tissue homogenate CrAg testing can be helpful in improving the diagnosis of PC.
基金This work was supported by the grants from Guangzhou Programs for Natural Science Foundation of Guangdong Province （No. 201707010282）, Scientific Research Project of Guangzhou （No. 2017A030310286）, the National Natural Science Foundation of China （No. 81670071 ）, and Science and Technology Planning Project of Guangdong Province （No. 2014A020212627）.
文摘Background： Serum cryptococcal antigen （CrAg） test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus （HIV） adult patients with pulmonary cryptococcosis and its clinical features. Methods： One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive （CrAg＋ group） and 29 were negative （CrAg- group）. It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio （OR） was used to measure correlation. Student＇s t-test was obtained to analyze continuous variable. Results： No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups （P 〉 0.05 in all）. Nevertheless, diffuse extent lesion was 82.1% in CrAg＋ group and 10.3% in CrAg- group （χ2 = 40.34, P〈 0.001; OR = 39.87）. Conclusions： Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.
文摘THE causes of Cushing＇s syndrome are mainly di- vided into adrenocorticotropic hormone （ACTH） dependent and independent. ACTH dependent hypercortisolism represents excess ACTH se-creting by the pituitary or tumor outside the pituitary; and the latter one is also called as ectopic ACTH syndrome. Thorax is the most common location of causative lesions for ectopic ACTH syndrome, and the size of lesion is too small to be detected in some cases.1＇ 2 Cryptococcal pneumonia usually occurs in immunocompromised patients and excess cortisol production can theoretically produce a state of immunodeficiency. Development of cryptococcal pneumonia concomitant with Cushing syndrome （CS） was rare. Here, we report a case of pulmonary nodule in a patient with CS differentiated with ectopic ACTH-producing tumor. Crypto- coccal pneumonia was diagnosed followinglung resection.
