Cryptococcal invasion: a comprehensive case of adrenal and systemic infection amid immunosuppression.
Adrenal cryptococcosis
Adrenalectomy
Disseminated cryptococcosis
Immunosuppress
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
08 Oct 2024
08 Oct 2024
Historique:
received:
03
06
2024
accepted:
08
08
2024
medline:
9
10
2024
pubmed:
9
10
2024
entrez:
8
10
2024
Statut:
epublish
Résumé
We report a case of disseminated cryptococcosis, an uncommon fungal infection predominantly affecting the lungs and central nervous system, with the rare involvement of adrenal cryptococcosis, compounded by meningitis and pneumonia. The patient, previously diagnosed with primary myelofibrosis and undergoing oral Ruxolitinib treatment, exhibited immunosuppression. Imaging via chest and abdominal CT scans revealed inflammation in the right lung's middle lobe, splenomegaly, a splenic lesion, and a left adrenal mass, initially prompting considerations of pheochromocytoma. However, unilateral adrenalectomy and subsequent pathological examination disclosed extensive infiltration by inflammatory and multinucleate giant cells, with Periodic acid-Schiff (PAS) staining confirming the diagnosis. The identification of adrenal cryptococcosis was further supported by positive adrenal pus culture and significantly elevated capsular antigens in both serum and cerebrospinal fluid, at titers of 1:2560. Following a month of oral antifungal treatment, marked reductions in capsular antigen levels were noted, to 1:640 and 1:160 in serum and cerebrospinal fluid, respectively. The patient was discharged on a regimen of oral amphotericin B, flucytosine, and fluconazole, with regular outpatient follow-ups showing no signs of recurrence or dissemination.
Identifiants
pubmed: 39379806
doi: 10.1186/s12879-024-09737-8
pii: 10.1186/s12879-024-09737-8
doi:
Substances chimiques
Antifungal Agents
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1119Subventions
Organisme : Anhui Provincial Natural Science Foundation
ID : 2108085MH295
Organisme : Anhui Provincial Natural Science Foundation
ID : 2108085MH295
Informations de copyright
© 2024. The Author(s).
Références
Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america[J]. Clin Infect Dis. 2010;50(3):291–322.
doi: 10.1086/649858
pubmed: 20047480
Wappler-Guzzetta EA, Gray AL, Dagostino J et al. Diffuse adrenal gland and pancreas necrosis in a patient with disseminated cryptococcosis-case Report[J]. Life (Basel), 2022, 12(10).
Kawamura M, Miyazaki S, Mashiko S, et al. Disseminated cryptococcosis associated with adrenal masses and insufficiency[J]. Am J Med Sci. 1998;316(1):60–4.
pubmed: 9671046
Hung ZS, Lai YH, Hsu YH, et al. Disseminated cryptococcosis causes adrenal insufficiency in an immunocompetent individual[J]. Intern Med. 2010;49(11):1023–6.
doi: 10.2169/internalmedicine.49.3051
pubmed: 20519820
Walker BF, Gunthel CJ, Bryan JA, et al. Disseminated cryptococcosis in an apparently normal host presenting as primary adrenal insufficiency: diagnosis by fine needle aspiration[J]. Am J Med. 1989;86(6 Pt 1):715–7.
doi: 10.1016/0002-9343(89)90453-1
pubmed: 2658577
Hsu E, Webster SM, Nanes M. Disseminated cryptococcosis in an immunocompetent host presenting as Osteomyelitis and leading to adrenal Insufficiency[J]. Am J Med Sci. 2022;363(1):75–9.
doi: 10.1016/j.amjms.2020.12.007
pubmed: 35033296
Takeshita A, Nakazawa H, Akiyama H, et al. Disseminated cryptococcosis presenting with adrenal insufficiency and meningitis: resistant to prolonged antifungal therapy but responding to bilateral adrenalectomy[J]. Intern Med. 1992;31(12):1401–5.
doi: 10.2169/internalmedicine.31.1401
pubmed: 1300177
Ranjan P, Jana M, Krishnan S, et al. Disseminated cryptococcosis with adrenal and lung involvement in an immunocompetent patient[J]. J Clin Diagn Res. 2015;9(4):Od04–5.
pubmed: 26023583
pmcid: 4437098
Ito M, Hinata T, Tamura K, et al. Disseminated cryptococcosis with adrenal insufficiency and meningitis in an Immunocompetent Individual[J]. Intern Med. 2017;56(10):1259–64.
doi: 10.2169/internalmedicine.56.7356
pubmed: 28502948
pmcid: 5491828
Cocker R, Mcnair SA, Kahn L, et al. Isolated adrenal cryptococcosis, diagnosed by fine-needle aspiration biopsy: a case report[J]. Diagn Cytopathol. 2014;42(10):899–901.
doi: 10.1002/dc.23079
pubmed: 24610787
Liu YC, Cheng DL, Liu CY, et al. Isolated cryptococcosis of the adrenal gland[J]. J Intern Med. 1991;230(3):285–7.
doi: 10.1111/j.1365-2796.1991.tb00445.x
pubmed: 1895053
Muraoka Y, Iwama S, Arima H. Normalization of Bilateral Adrenal Gland Enlargement after Treatment for Cryptococcosis[J]. Case Rep Endocrinol, 2017, 2017: 1543149.
Matsuda Y, Kawate H, Okishige Y, et al. Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report[J]. BMC Infect Dis. 2011;11:340.
doi: 10.1186/1471-2334-11-340
pubmed: 22166121
pmcid: 3254187
Liu Y, L W W S LL, He PC, Liu HB. The clinical and pathological features analysis of bone marrow in myelofibrosis[J]. Anhui Med Pharm J. 2015;19(12):2335–8.
Jiang S, Sun L, Zhang SY, Wang T, Xu YF. Effects of JAK1/2 inhibitor ruxolitinib on the Survival and Immune function of Neutrophils[J]. Chin J Cell Biology. 2022;44(5):826–35.
Ten S, New M, Maclaren N. Clinical review 130: Addison’s disease 2001. J Clin Endocrinol Metab. 2001;86:2909–22.
pubmed: 11443143
Wlodek C, Ng Y, Bovill B, et al. An unusual cause of cutaneous Ulceration. Clin Exp Dermatol. 2017;42:226–9. [PMID: 28044361].
doi: 10.1111/ced.13007
pubmed: 28044361