Criptococosis pulmonar en una paciente con artritis reumatoide en la era COVID: reporte de caso

Mayra Valderrama-Saldaña; Carmen Ortiz-Santillán; Mario J. Agramonte; Gustavo R. Liendo; José Somocurcio-Peralta

doi:10.35663/amp.2024.414.3058

Authors

Mayra Valderrama-Saldaña Servicio de Neumología, Hospital Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0002-3670-7767
Carmen Ortiz-Santillán Servicio de Neumología, Hospital Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0009-0008-6501-9833
Mario J. Agramonte Servicio de Infectología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0003-1023-0689
Gustavo R. Liendo Servicio de Medicina Interna, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0001-5485-5141
José Somocurcio-Peralta Servicio de Anatomía Patológica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0002-5198-4113

DOI:

https://doi.org/10.35663/amp.2024.414.3058

Keywords:

Cryptococcosis, Lung, Cryptococcosis, Fungal lung diseases

Abstract

Pulmonary cryptococcosis (PC) primarily affects immunosuppressed individuals, though not exclusively. The clinical presentation is variable, and reaching a diagnosis is challenging, tuberculosis and cancer being the main differential diagnoses. Due to the neurotropism of this microorganism, cerebrospinal fluid (CSF) analysis is mandatory. Treatment depends on the severity and extent of the disease, as well as the patient's immune status. We present the case of a 74-year-old patient with rheumatoid arthritis, who was being treated with prednisone, leflunomide, and methotrexate. Following a mild COVID-19 diagnosis six months prior to admission, she developed chest pain, productive cough, and progressive dyspnea. A chest CT scan revealed multiple bilateral pulmonary consolidation foci. Histological examination of tissue obtained via transthoracic percutaneous biopsy was consistent with cryptococcosis. India ink stain and cryptococcal antigen (CrAg) tests were negative in cerebrospinal fluid, while the serum CrAg was positive. Oral fluconazole was initiated, and the patient had a favorable response.

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References

1. Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2016;30(1):179-206. doi: 10.1016/j.idc.2015.10.006.

2. Durán QNC, Caro LJ, Gómez RJE, Pérez CRO, Zúñiga CIR. COVID-19: un factor de riesgo para mucormicosis y criptococosis. Reporte de caso. Enf Infec Microbiol. 2022;42(3):142-145.

3. Nair AV, Ramanathan S, Sanghavi P, Manchikanti V, Satheesh S, Al-Heidous M, et al. Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber. Radiologia. 2022;64(6):533-541. doi: 10.1016/j.rx.2022.06.006.

4. Gushiken AC, Saharia KK, Baddley JW. Cryptococcosis. Infect Dis Clin North Am. 2021;35(2):493-514. doi: 10.1016/j.idc.2021.03.012.

5. Mazzei JA. COVID -19: una nueva enfermedad respiratoria y una posible amenaza mundial. Rev Am Med Respir. 2020;20(1).

6. Dai Q, Wang Y, Ying Q, Ye Q. Cryptococcosis with pulmonary cavitation in an immunocompetent child: a case report and literature review. BMC Infect Dis. 2024;24(1):162. doi: 10.1186/ s12879-024-09061-1.

7. Wang DX, Zhang Q, Wen QT, Ding GX, Wang YG, Du FX, et al. Comparison of CT findings and histopathological characteristics of pulmonary cryptococcosis in immunocompetent and immunocompromised patients. Scientific Reports. 2022;12(1):5712. doi: 10.1038/s41598-022-09794-6.

8. Howard-Jones AR, Sparks R, Pham D, Halliday C, Beardsley J, Chen SC. Pulmonary Cryptococcosis. J Fungi (Basel). 2022;8(11):1156. doi: 10.3390/jof8111156.

9. Kohno S, Kakeya H, Izumikawa K, Miyazaki T, Yamamoto Y, Yanagihara K, et al. Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan. J Infect Chemother. 2015;21(1):23-30. doi: 10.1016/j.jiac.2014.08.025.

10. Yamamura D, Xu J. Update on Pulmonary Cryptococcosis. Mycopathologia. 2021;186(5):717-728. doi: 10.1007/s11046-021- 00575-9.

11. Timmermann FR, Morales-Cauti S, Villacaqui AE. Cryptococcus neoformans in faeces of feral and homing pigeons (Columba livia) in Lima, Peru. Rev Investig Vet Perú. 2020;31 (3):e18732. doi: 10.15381/rivep.v31i3.18732.

12. Juárez-Campos CE, Hinojosa-Curiel S, Baeza-Casillas JA, ReyesGómez U, López-Cruz G, Reyes-Hernández KL, et al. Micosis pulmonar: cuándo sospecharla. Salud Jalisco 2023;10(3):173-178. doi: 10.35366/113308.

13. Kassaza K, Wasswa F, Nielsen K, Bazira J. Cryptococcus neoformans Genotypic Diversity and Disease Outcome among HIV Patients in Africa. J Fungi (Basel). 2022;8(7):734. doi: 10.3390/jof8070734.

14. Xin Z, Li B, Xue W, Lin W, Zhao Q, Zhang X. Pulmonary cryptococcosis mimicking lung cancer: 3 case report. Int J Surg Case Rep. 2022;94:106973. doi: 10.1016/j.ijscr.2022.106973.

15. Poli S, Sciorio F, Piacentini G, Pietrobelli A, Pecoraro L, Pieropan S. Acute Respiratory Failure in Autoimmune Rheumatic Diseases: A Review. Journal of Clinical Medicine. 2024; 13(10):3008. doi: 10.3390/jcm13103008.

16. Ávila GP, Lourenço MG, Figueiredo EV, Pinheiro LM, Silva HSL da, Almeida EMR de. Diagnóstico de criptococose pulmonar simulando quadro clínico de neoplasia em paciente imunocompetente na Amazônia brasileira: relato de caso. Braz J Hea Rev. 2024;7(2):e68337. doi: 10.34119/bjhrv7n2-199.

17. Howard-Jones AR, Sparks R, Pham D, Halliday C, Beardsley J, Chen SC. Pulmonary Cryptococcosis. J Fungi (Basel). 2022;8(11):1156. doi: 10.3390/jof8111156.

18. Masur H, Brooks JT, Benson CA, Holmes KK, Pau AK, Kaplan JE, et al. Prevention and treatment of opportunistic infections in HIVinfected adults and adolescents: Updated Guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(9):1308-11. doi: 10.1093/cid/ciu094.

19. Chan K-S, Lai C-C, Yu W-L, Chao C-M. COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic. Journal of Fungi. 2022;8(10):1111. doi: 10.3390/jof8101111.