Korean J Clin Microbiol.  2011 Dec;14(4):148-152. 10.5145/KJCM.2011.14.4.148.

Two Cases of Cryptococcuria Developed as Isolated Cryptococcuria and Disseminated Cryptococcosis

Affiliations
  • 1Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. mnkim@amc.seoul.kr
  • 2Division of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 3Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Abstract

Cryptococcus is an opportunistic pathogen that mainly affects immunocompromised hosts and, less frequently, immunocompetent hosts. It causes serious morbidity and mortality due to systemic infections such as meningoencephalitis and pulmonary infection. Urinary involvement of Cryptococcus is sometimes reported among cases of disseminated cryptococcosis in AIDS patients, but no such reports have been published in Korea. We report two cases of cryptococcuria that developed in a 71-year old female with diabetes and liver cirrhosis and in a 50-year old male who received a liver transplant due to HBV-associated hepatic failure. The female patient had received prednisolone for 12 days before we detected C. neoformans in urine culture. Even though no antifungal therapy was indicated for cryptococcuria, following urine culture became negative, but still positive for cryptococcal antigen on hospital day 25. Her blood, CSF culture, and antigen tests were negative, and therefore she was diagnosed with isolated cryptococcuria. The male patient had received prednisolone and tacrolimus for 10 days before sputum and urine cultures became positive for C. neoformans. He had ill defined nodules and pleural effusion in both lungs on chest CT. His cryptococcuria was sustained for over 2 months, despite receiving amphotericin B treatment. His cryptococcuria seemed to be a symptom of disseminated cryptococcosis.

Keyword

Cryptococcus neoformans; Cryptococcuria; Urine; Culture

MeSH Terms

Amphotericin B
Cryptococcosis
Cryptococcus
Cryptococcus neoformans
Female
Humans
Immunocompromised Host
Korea
Liver
Liver Cirrhosis
Liver Failure
Lung
Male
Meningoencephalitis
Pleural Effusion
Prednisolone
Sputum
Tacrolimus
Thorax
Transplants
Amphotericin B
Prednisolone
Tacrolimus

Figure

  • Fig. 1. Chest X-ray and CT of two patients. Patient 1 showed slightly increased patchy ground glass opacity in right upper lobe on chest X-ray (A) and areas of patch ground glass opacity in right upper lobe and diffuse bronchial wall thickening in both lungs on CT suggesting focal pneumonia (B). Patient 2 showed no active lung lesion on chest X-ray (C), but patchy faint ground glass opacities and small amount of right pleural effusion on CT at HD 25 (D).

  • Fig. 2. Germ tube test of the isolates from the patient 1. 3-4 μm spherical yeasts showed single budding connected with a narrow neck and negative germ tube reaction (×400).


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