Pleural effusion in an immunocompetent host with cryptococcal pneumonia: A case report

Wu, Huan-Huan; Chen, Yan-Xiao; Fang, Shuang-yan

doi:10.12998/wjcc.v8.i7.1295

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…However, cryptococcal pneumonia coexisting with lung adenocarcinoma is very rare. Huang J et al reported a case series of eight patients with concomitant lung adenocarcinoma and cryptococcal pneumonia [ 14 ]. There have been other cases of similar presentation reported in the literature [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Pneumonia in an Immunocompetent Patient: A Rare Occurrence

Haider¹,

Master²,

Mahtani³

et al. 2022

Cureus

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Cryptococcosis is an invasive yeast infection commonly found among immunosuppressed patients. Pulmonary cryptococcal infection can have variable presentations ranging from pulmonary nodules and masses to consolidation. A patient can present with shortness of breath, cough, sputum production, chest pain, fatigue, and weight loss. Diagnosis can be made using fungal culture, histology, radiographic findings, and cryptococcal antigen in serum as well as in the cerebrospinal fluid. Treatment is usually with a combination or a single antifungal agent. Few cases have been reported in immunocompetent individuals.Here we present a case of 69-year-old immunocompetent individual, who was initially seen in the outpatient clinic for dyspnea, cough, and fatigue and was treated for pneumonia. The patient remained symptomatic despite multiple courses of oral antibiotics. He was then sent for inpatient admission. CT scan was obtained that showed patchy infiltrates and consolidations, followed by bronchoscopy. The cytology confirmed adenocarcinoma. The fungal smear and culture grew Cryptococcus neoformans. The patient was treated with fluconazole with improvement of his symptoms before starting chemotherapy.We are reporting this case as clinicians usually focus on bacterial etiologies in outpatient setting. Our patient, who was immunocompetent, had a new diagnosis of cryptococcal pneumonia and was also found to have lung adenocarcinoma. This case highlights the rare occurrence of this type of pneumonia in immunocompetent patients and the importance of considering fungal causes of pneumonia in patients.

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Section: Discussionmentioning

confidence: 99%

Cryptococcal Pneumonia in an Immunocompetent Patient: A Rare Occurrence

Haider¹,

Master²,

Mahtani³

et al. 2022

Cureus

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“…We also targeted alpha-lactalbumin (milk protein), which proved markedly positive within alveolar and macrophage reservoirs, linking the pneumonia to aspiration of milk. Owing to combined use of PMCT and immunohistochemistry, a cause of death was conclusively determined in this case of SUID[ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration: A case report

Maiese¹,

Russa²,

Arcangeli³

et al. 2020

WJCC

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BACKGROUND The term sudden unexpected infant death (SUID) is not always properly invoked. It refers to a broad range of conditions that sometimes defy classification. There is not only a strong emotional impact on the family, but such cases are also quite complex. Underlying causes may be multiple, not always readily apparent, and have potential repercussions, especially in terms of forensics. CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest. The parents had immediately rushed their child to the hospital, stating the baby was found prone and not breathing. Total-body postmortem computed tomography (PMCT) was performed, revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change. At autopsy, the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material. There was widespread airspace reduction due to parenchymal collapse. Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells. Immunohistochemical studies were performed, targeting CD15, CD68, and alpha-lactalbumin. Ultimately, the focus was on alpha-lactalbumin (milk protein), which showed marked immunopositivity within alveolar spaces. Cytoplasmic staining of macrophages was also particularly prominent. CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances. PMCT is a useful tool in this setting, given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases. These findings, later confirmed by immunohistochemical investigations, were indicative of active pneumonia due to aspirated milk. The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern. PMCT is a very valuable aid in cases of forensic interest, as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

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“…We read with interest a case report by Wu et al [ 1 ], who described a case of a 29-year-old male, immunocompetent host with cryptococcal pneumonia accompanied by pleural effusion. In that case, chest imaging showed scattered numerous cavities in the superior segment of the left lower lobe with a rough cavity wall and a cavity and pleural effusion in the anterior segment of the left lower lobe[ 1 ].…”

Section: To the Editormentioning

confidence: 99%

“…Moreover, it has been reported that pleural effusion CrAg has higher sensitivity than serum CrAg test in patients with pleural effusion as the only clinical presentation of cryptococcal infection[ 17 ]. However, the diagnosis of cryptococcal pleural effusion in the case by Wu et al [ 1 ] was made by positive serum CrAg, positive India ink staining of bronchoalveolar lavage fluid, and positive PAS staining for Cryptococcus of lung tissue obtained by percutaneous lung biopsy, while neither pleural aspiration nor pleural biopsy was reported[ 1 ].…”

Section: To the Editormentioning

confidence: 99%

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Pleural involvement in cryptococcal infection

Georgakopoulou¹,

Damaskos²,

Sklapani³

et al. 2022

WJCC

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Pleural involvement of cryptococcal infection is uncommon and is more commonly observed in immunocompromised hosts than in immunocompetent ones. Pleural involvement in cryptococcal infections can manifest with or without pleural effusion. The presence of Cryptococcus spp. in the effusion or pleura is required for the diagnosis of cryptococcal pleural infection, which is commonly determined by pleural biopsy, fluid culture, and/or detection of cryptococcal antigen in the pleura or pleural fluid.

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Pleural effusion in an immunocompetent host with cryptococcal pneumonia: A case report

Cited by 6 publications

References 12 publications

Cryptococcal Pneumonia in an Immunocompetent Patient: A Rare Occurrence

Cryptococcal Pneumonia in an Immunocompetent Patient: A Rare Occurrence

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration: A case report

Pleural involvement in cryptococcal infection

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