TITLE

Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review

AUTHOR(S)
Mayun Chen; Xiaomi Wang; Xianjuan Yu; Caijun Dai; Dunshun Chen; Chang Yu; Xiaomei Xu; Dan Yao; Li Yang; Yuping Li; Liangxing Wang; Xiaoying Huang; Chen, Mayun; Wang, Xiaomi; Yu, Xianjuan; Dai, Caijun; Chen, Dunshun; Yu, Chang; Xu, Xiaomei; Yao, Dan
PUB. DATE
September 2015
SOURCE
BMC Infectious Diseases;9/23/2015, Vol. 15 Issue 1, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Background: Cryptococcus neoformans infection usually presents as chronic meningitis and is increasingly being recognized in immunocompromised patients. Presentation with pleural effusion is rare in cryptococcal disease; in fact, only 4 cases of pleural effusion as the initial clinical presentation in cryptococcosis have been reported in English-language literature to date. We report the first case of pleural effusion as the initial clinical presentation in a renal transplant recipient who was initially misdiagnosed with tuberculous pleuritis but who then developed fungaemia and disseminated cryptococcosis. The examination of this rare manifestation and the accompanying literature review will contribute to increased recognition of the disease and a reduction in misdiagnoses.Case Presentation: We describe a 63-year-old male renal transplant recipient on an immunosuppressive regimen who was admitted for left pleural effusion and fever. Cytological examinations and pleural fluid culture were nonspecific and negative. Thoracoscopy only found chronic, nonspecific inflammation with fibrosis in the pleura. After empirical anti-tuberculous therapy, the patient developed an elevated temperature, a severe headache and vomiting and fainted in the ward. Cryptococci were specifically found in the cerebrospinal fluid following lumbar puncture. Blood cultures were twice positive for C. neoformans one week later. He was transferred to the respiratory intensive care unit (RICU) immediately and was placed on non-invasive ventilation for respiratory failure for 2 days. He developed meningoencephalitis and fungaemia with C. neoformans during hospitalization. He was given amphotericin B liposome combined with 5-flucytosine and voriconazole for first 11 days, then amphotericin B liposome combined with 5-flucytosine sustained to 8 weeks, after that changed to fluconazole for maintenance. His condition improved after antifungal treatment, non-invasive ventilation and other support. Further pathological consultation and periodic acid-Schiff staining revealed Cryptococcus organisms in pleural sections, providing reliable evidence for cryptococcal pleuritis.Conclusion: Pleural effusion is an unusual manifestation of cryptococcosis. Cryptococcal infection must be considered in the case of patients on immunosuppressives, especially solid-organ transplant recipients, who present with pleural effusion, even if pleural fluid culture is negative. Close communication between the pathologist and the clinician, multiple special biopsy section stains and careful review are important and may contribute to decreasing misdiagnosis.
ACCESSION #
109884156

 

Related Articles

  • Emergence of multiple resistance profiles involving azoles, echinocandins and amphotericin B in Candida glabrata isolates from a neutropenia patient with prolonged fungaemia. Eun-Jung Cho; Jong Hee Shin; Soo Hyun Kim; Hyun-Ki Kim; Jeong Su Park; Heungsup Sung; Mi-Na Kim; Ho Joon Im // Journal of Antimicrobial Chemotherapy (JAC);Apr2015, Vol. 70 Issue 4, p1268 

    The article describes the case of a male patient with prolonged fungaemia who developed multiple resistance to Candida glabrata. Particular focus is given to the patient's medical history, as well as treatment regimens. Topics discussed include antifungal susceptibility testing of clinical...

  • Intraleukocytic Candida is Diagnostic of Pathological Candidemia. Handoo, Anil; Nagoti, Sarada; Choudhary, Adarsh // Turkish Journal of Hematology;Dec2012, Vol. 29 Issue 4, p439 

    The article presents an overview of candidemia, which is the presence of Candida species in human blood, and discusses the role that intraleukocytic Candida plays in the diagnosis of pathological candidemia. The case of a 16 year old male patient who developed candidemia and died as a result is...

  • The difficult management of disseminated Sporothrix brasiliensis in a patient with advanced AIDS. Gomes Paixão, Ariane; Gutierrez Galhardo, Maria Clara; Almeida-Paes, Rodrigo; Portela Nunes, Estevão; Carvalho Gonçalves, Marcelo Luiz; Larias Chequer, Gisele; da Cruz Lamas, Cristiane // AIDS Research & Therapy;2015, Vol. 12 Issue 1, p1 

    Sporotrichosis is an infection caused by a dimorphic fungus of the Sporothrix schenckii complex. Host immunity is an important factor in the clinical manifestations of the disease. Deeply immunocompromised individuals, especially those infected with the Human Immunodeficiency Virus (HIV) and T...

  • Treatment and outcomes of Candida osteomyelitis: review of 53 cases from the PATH Alliance® registry. Neofytos, D.; Huprikar, S.; Reboli, A.; Schuster, M.; Azie, N.; Franks, B.; Horn, D. // European Journal of Clinical Microbiology & Infectious Diseases;Jan2014, Vol. 33 Issue 1, p135 

    Candida osteomyelitis is associated with significant morbidity; however, data on the management of Candida osteomyelitis are limited. The Prospective Antifungal Therapy (PATH) Alliance® registry is a comprehensive, multicenter, prospective, observational registry that collected data on...

  • Red cell exchange transfusion as a rescue therapy for tacrolimus toxicity in a paediatric renal transplant. McCarthy, Hugh; Inward, Carol; Marriage, Steve; Astley, Peter; Tizard, E. // Pediatric Nephrology;Dec2011, Vol. 26 Issue 12, p2245 

    Tacrolimus is a widely used macrolide immunosuppressant that has a narrow therapeutic index and potential side effects including neurotoxicity. A 20-month-old boy with kidney disease secondary to prune belly syndrome variant, managed on peritoneal dialysis, received a deceased donor transplant....

  • Topics in Infectious Diseases. Ellickalputhenpura, Bena E.; Torres, Harrys A. // JAAPA: Journal of the American Academy of Physician Assistants (;Dec2012, Vol. 25 Issue 12, p18 

    The article describes the pathophysiology and management of histoplasmosis, an infectious disease caused by inhalation of microconidia of Histoplasma capsulatum. It reports that the symptoms of it include asymptomatic, pulmonary, disseminated histoplasmosis. It highlights that bronchoalveolar...

  • Trichosporon beigelii Funguria in Renal Transplant Recipients. Lussier, N.; Laverdiere, M.; Delorme, J.; Weiss, K.; Dandavino, R. // Clinical Infectious Diseases;11/1/2000, Vol. 31 Issue 5, p1299 

    Presents a study on the trichosporon beigelii funguria in renal transplant patients. Information on trichosporon beigelii; Details on renal transplant recipients who experienced trichosporon beigelii funguria; Use of antifungal therapy for invasive infections caused by trichosporon beigelii.

  • IDENTIFICATION OF FUNGAL KERATITIS AGENTS IN THE EAST OF MAZANDARAN AREA BY PCR AND DETERMINATION OF THEIR DRUG SENSITIVITY. Nikpour, Shaghayegh; Omran, Ayatollah Nasrollahi; Omran, Saeid Mahdavi; Karmi, Azar // Jundishapur Journal of Microbiology;2013 Special Edition, p77 

    Introduction and Objectives: Fungal infection causes extensive infective ocular ulcer worldwide and can due to morbidity and blindness. Keratitis is prevalent in tropical and developing countries. For diagnosis and treatment fungal infection is one of the most challenging causes of corneal...

  • Necrotizing vasculitis secondary to disseminated histoplasmosis simulating pyoderma gangrenosum. Vinicki, Juan P.; Tiraboschi, Iris N.; Fernandez, Daniel; Dubinsky, Diana; Laborde, Hugo A.; Nasswetter, Gustavo // Rheumatology;Dec2013, Vol. 52 Issue 12, p2304 

    The article presents the case of a 60-year-old woman who had left lower limb ulcer that simulated the ulcerative skin disease pyoderma gangrenosum. The patient did not respond to corticosteroid therapy and she was treated with itraconazole with optimal response. It is noted that antibiotic...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics