Pulmonary cryptococcosis complicating interstitial lung disease in a patient with systemic lupus erythematosus

Abstract

We report a case of primary pulmonary cryptococcosis in a 59-year-old female patient with a history of systemic lupus erythematosus, interstitial lung disease and glaucoma. She presented with a cough, severe fatigue, unintentional weight loss, shortness of breath (increase in home oxygen use from baseline) and pleuritic chest pain of 2 months duration. During these 2 months, her symptoms had worsened despite multiple hospital visits, empirical antibiotics and empirical increase of her steroid dosage. Cytopathology of the bronchoalveolar lavage fluid showed yeast cells with narrow-based budding and grew Cryptococcus neoformans on fungal culture. She was treated with oral fluconazole 400 mg/day for 6 months with an improvement in cough, decrease in shortness of breath (return to baseline oxygen use) and resolution of pleuritic chest pain.

Respiratory Manifestations in Systemic Lupus Erythematosus

“…Viral infections have been reported in particular with cytomegalovirus and varicella zoster virus, often in the context of a disseminated infection. SLE patients are also at increased risk for tuberculosis and infections with non-tuberculous mycobacteria [ 120 , 121 , 122 , 123 , 124 , 125 , 126 ]. Protozoa infections, also with rare pathogens such as Lophomonas blattarum, have been reported [ 127 ].…”