Tuberc Respir Dis.  1997 Oct;44(5):1083-1093.

Clinical Characteristics of Pulmonary Cryptococcosis

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
  • 2Department of Thoracic Surgery, College of Medicine, Hanyang University, Seoul, Korea.

Abstract

BACKGROUND: So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases.
METHODS
The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained.
RESULTS
Cryptococcosis occured frequently over sixth decade and the male to female ratio was 3.6:1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnosis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture ,serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities.
CONCLUSION
Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnostic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.

Keyword

Pulmonary cryptococcosis; Clinical manifestation

MeSH Terms

Adrenalectomy
Amphotericin B
Anti-Bacterial Agents
Arthritis, Rheumatoid
Biopsy
Biopsy, Fine-Needle
Cryptococcosis*
Cryptococcus neoformans
Diabetes Mellitus
Diagnosis
Diagnostic Errors
Female
Fluconazole
Flucytosine
Hepatitis, Autoimmune
Humans
Ketoconazole
Kidney Transplantation
Korea
Latex Fixation Tests
Lung
Lymphatic Diseases
Male
Pleural Effusion
Retrospective Studies
Serologic Tests
Sputum
Thoracotomy
Tuberculosis, Pulmonary
Amphotericin B
Anti-Bacterial Agents
Fluconazole
Flucytosine
Ketoconazole
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