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Multiple fungal infection in a patient on chronic low dose corticotherapy.

Yamazato S, Nakai N, Katoh N - Indian J Dermatol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: nnakai@koto.kpu-m.ac.jp.

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Here, we describe the rare case of simultaneous infection with Cryptococcus, Aspergillus, and Tinea in a patient on chronic low dose corticotherapy... An initial physical examination in our department showed scaly erythema over the whole body with fever (37.7°C) and general malaise [Figure 1a and b]... Oxygen saturation decreased to 88% under room air with dyspnea... The white blood cell count (8200/μl; normal range, 3400-7300/μl), including neutrophils (6158/μl; normal range, 1214-5110/μl), serum levels of C-reactive protein (CRP) (9.78 mg/dl; normal range, 0-0.2 mg/dl), Krebs von den Lungen-6 (773 U/ml; normal range 0-499 U/ml), and beta-D-glucan (54.2 pg/ml; normal range, 0-10.9 pg/ml) were elevated... On day 6, worsening of reticular opacities on CT was detected, and on day 7, serum CRP levels increased to above 15 mg/dl... In addition, positive serum Aspergillus galactomannan antigen (cut-off index, 1.0; normal range, 0-0.4) was confirmed... We diagnosed this case as cutaneous cryptococcosis accompanied with pulmonary aspergillosis... The eruption, respiratory symptoms, and the CRP level had improved with intravenous administration of amphotericin B 150 mg/day for 3 days followed by voriconazole 450 mg/day for 15 days... Our case showed fever, worsening respiratory function, elevated levels of serum beta-D-glucan, and positive serum Aspergillus galactomannan antigen, suggesting a possibility of invasive pulmonary aspergillosis... The histopathological confirmation of cryptococcus fungi and negative serum cryptococcal antigen result also suggested primary cutaneous cryptococcosis... The patient had worked in agriculture for over 50 years, making opportunities for traumatic inoculation of cryptococcus fungus frequent... The simultaneous presence of multiple fungal infections is very rare... In our case, immunosuppression caused by chronic low dose corticotherapy may have been associated with the multiple fungal infections and the case illustrates the importance of medical practitioners paying attention to chronic corticotherapy.

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Clinical photographs (a and b) and histopathological studies (c and d). (a) Chest and abdomen. (b) Back, showing severe scaly erythema. (c) Histological findings in hematoxylin and eosin-stained sections showed histiocytic granulomas with neutrophils in dermis. Numerous round bodies were identified in the center of the granuloma (original magnification ×200). (d) Grocott staining showed black-brown fungi in the histiocytic granuloma (original magnification ×400)
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Figure 1: Clinical photographs (a and b) and histopathological studies (c and d). (a) Chest and abdomen. (b) Back, showing severe scaly erythema. (c) Histological findings in hematoxylin and eosin-stained sections showed histiocytic granulomas with neutrophils in dermis. Numerous round bodies were identified in the center of the granuloma (original magnification ×200). (d) Grocott staining showed black-brown fungi in the histiocytic granuloma (original magnification ×400)

Mentions: An 85-year-old Japanese farmer was referred to our department for inpatient hospital care for severe eruption and fever. He had been treated with dexamethasone 1.0 mg oral tablets for 3 months at a private dermatology clinic because of pruritis on his trunk and extremities. An initial physical examination in our department showed scaly erythema over the whole body with fever (37.7°C) and general malaise [Figure 1a and b]. Oxygen saturation decreased to 88% under room air with dyspnea. The white blood cell count (8200/μl; normal range, 3400-7300/μl), including neutrophils (6158/μl; normal range, 1214-5110/μl), serum levels of C-reactive protein (CRP) (9.78 mg/dl; normal range, 0-0.2 mg/dl), Krebs von den Lungen-6 (773 U/ml; normal range 0-499 U/ml), and beta-D-glucan (54.2 pg/ml; normal range, 0-10.9 pg/ml) were elevated. Sputum cultures and routine blood cultures were negative. Tinea infections on the body were identified by a potassium hydroxide test. Chest computed tomography (CT) showed reticular opacities and emphysema, which suggested possible pneumocystis carinii pneumonia, bacterial pneumonia, or interstitial pneumonia. A skin biopsy from scaly erythematous lesion of the abdomen was consistent with cryptococcosis [Figure 1c and d].


Multiple fungal infection in a patient on chronic low dose corticotherapy.

Yamazato S, Nakai N, Katoh N - Indian J Dermatol (2014)

Clinical photographs (a and b) and histopathological studies (c and d). (a) Chest and abdomen. (b) Back, showing severe scaly erythema. (c) Histological findings in hematoxylin and eosin-stained sections showed histiocytic granulomas with neutrophils in dermis. Numerous round bodies were identified in the center of the granuloma (original magnification ×200). (d) Grocott staining showed black-brown fungi in the histiocytic granuloma (original magnification ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Clinical photographs (a and b) and histopathological studies (c and d). (a) Chest and abdomen. (b) Back, showing severe scaly erythema. (c) Histological findings in hematoxylin and eosin-stained sections showed histiocytic granulomas with neutrophils in dermis. Numerous round bodies were identified in the center of the granuloma (original magnification ×200). (d) Grocott staining showed black-brown fungi in the histiocytic granuloma (original magnification ×400)
Mentions: An 85-year-old Japanese farmer was referred to our department for inpatient hospital care for severe eruption and fever. He had been treated with dexamethasone 1.0 mg oral tablets for 3 months at a private dermatology clinic because of pruritis on his trunk and extremities. An initial physical examination in our department showed scaly erythema over the whole body with fever (37.7°C) and general malaise [Figure 1a and b]. Oxygen saturation decreased to 88% under room air with dyspnea. The white blood cell count (8200/μl; normal range, 3400-7300/μl), including neutrophils (6158/μl; normal range, 1214-5110/μl), serum levels of C-reactive protein (CRP) (9.78 mg/dl; normal range, 0-0.2 mg/dl), Krebs von den Lungen-6 (773 U/ml; normal range 0-499 U/ml), and beta-D-glucan (54.2 pg/ml; normal range, 0-10.9 pg/ml) were elevated. Sputum cultures and routine blood cultures were negative. Tinea infections on the body were identified by a potassium hydroxide test. Chest computed tomography (CT) showed reticular opacities and emphysema, which suggested possible pneumocystis carinii pneumonia, bacterial pneumonia, or interstitial pneumonia. A skin biopsy from scaly erythematous lesion of the abdomen was consistent with cryptococcosis [Figure 1c and d].

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: nnakai@koto.kpu-m.ac.jp.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Here, we describe the rare case of simultaneous infection with Cryptococcus, Aspergillus, and Tinea in a patient on chronic low dose corticotherapy... An initial physical examination in our department showed scaly erythema over the whole body with fever (37.7°C) and general malaise [Figure 1a and b]... Oxygen saturation decreased to 88% under room air with dyspnea... The white blood cell count (8200/μl; normal range, 3400-7300/μl), including neutrophils (6158/μl; normal range, 1214-5110/μl), serum levels of C-reactive protein (CRP) (9.78 mg/dl; normal range, 0-0.2 mg/dl), Krebs von den Lungen-6 (773 U/ml; normal range 0-499 U/ml), and beta-D-glucan (54.2 pg/ml; normal range, 0-10.9 pg/ml) were elevated... On day 6, worsening of reticular opacities on CT was detected, and on day 7, serum CRP levels increased to above 15 mg/dl... In addition, positive serum Aspergillus galactomannan antigen (cut-off index, 1.0; normal range, 0-0.4) was confirmed... We diagnosed this case as cutaneous cryptococcosis accompanied with pulmonary aspergillosis... The eruption, respiratory symptoms, and the CRP level had improved with intravenous administration of amphotericin B 150 mg/day for 3 days followed by voriconazole 450 mg/day for 15 days... Our case showed fever, worsening respiratory function, elevated levels of serum beta-D-glucan, and positive serum Aspergillus galactomannan antigen, suggesting a possibility of invasive pulmonary aspergillosis... The histopathological confirmation of cryptococcus fungi and negative serum cryptococcal antigen result also suggested primary cutaneous cryptococcosis... The patient had worked in agriculture for over 50 years, making opportunities for traumatic inoculation of cryptococcus fungus frequent... The simultaneous presence of multiple fungal infections is very rare... In our case, immunosuppression caused by chronic low dose corticotherapy may have been associated with the multiple fungal infections and the case illustrates the importance of medical practitioners paying attention to chronic corticotherapy.

No MeSH data available.


Related in: MedlinePlus