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A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy.

Sung JH, Kim do H, Oh MJ, Lee KJ, Bae YA, Kwon KW, Lee SM, Kang HJ, Choi J - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis.It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid.We treated him with fluconazole at 400 mg/day for 9 months according to the guideline.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea.

ABSTRACT
Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

No MeSH data available.


Related in: MedlinePlus

Supraclavicular lymph node biopsy. (A) Granulomatous inflammation in cryptococcosis showing numerous multinucleated giant cells (H&E stain). (B) The periodic acid-Schiff stain reveals yeast forms of Cryptococcus separated from the cell cytoplasm by a clear space. (C) The capsule of Cryptococcus stained bright-red with mucicarmine stain (A, ×100; B and C, ×400).
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Figure 2: Supraclavicular lymph node biopsy. (A) Granulomatous inflammation in cryptococcosis showing numerous multinucleated giant cells (H&E stain). (B) The periodic acid-Schiff stain reveals yeast forms of Cryptococcus separated from the cell cytoplasm by a clear space. (C) The capsule of Cryptococcus stained bright-red with mucicarmine stain (A, ×100; B and C, ×400).

Mentions: As results were inconclusive, we performed ultrasound-guided percutaneous left supraclavicular lymph node core needle biopsy. We stained the tissues with mucicarmine, periodic acid-Schiff, Grocott-Gomori's methenamine silver (Figure 2). These histopathological data led to the conclusion that he had been suffering from cryptococcal pneumonia. We took a lumbar puncture to exclude cryptococcal meningitis. There was no evidence of meningitis. The lab findings of CSF tapping showed a white blood cell count of 1/µL, a protein of 18.0 mg/dL, and a glucose of 91 mg/dL. We did not detect any microorganism on CSF tests including cryptococcal antigen test, India ink test, fungus cultures, Gram stain and culture, viral PCR (herpes simplex virus and varicella zoster virus), and tuberculosis PCR.


A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy.

Sung JH, Kim do H, Oh MJ, Lee KJ, Bae YA, Kwon KW, Lee SM, Kang HJ, Choi J - Tuberc Respir Dis (Seoul) (2015)

Supraclavicular lymph node biopsy. (A) Granulomatous inflammation in cryptococcosis showing numerous multinucleated giant cells (H&E stain). (B) The periodic acid-Schiff stain reveals yeast forms of Cryptococcus separated from the cell cytoplasm by a clear space. (C) The capsule of Cryptococcus stained bright-red with mucicarmine stain (A, ×100; B and C, ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499599&req=5

Figure 2: Supraclavicular lymph node biopsy. (A) Granulomatous inflammation in cryptococcosis showing numerous multinucleated giant cells (H&E stain). (B) The periodic acid-Schiff stain reveals yeast forms of Cryptococcus separated from the cell cytoplasm by a clear space. (C) The capsule of Cryptococcus stained bright-red with mucicarmine stain (A, ×100; B and C, ×400).
Mentions: As results were inconclusive, we performed ultrasound-guided percutaneous left supraclavicular lymph node core needle biopsy. We stained the tissues with mucicarmine, periodic acid-Schiff, Grocott-Gomori's methenamine silver (Figure 2). These histopathological data led to the conclusion that he had been suffering from cryptococcal pneumonia. We took a lumbar puncture to exclude cryptococcal meningitis. There was no evidence of meningitis. The lab findings of CSF tapping showed a white blood cell count of 1/µL, a protein of 18.0 mg/dL, and a glucose of 91 mg/dL. We did not detect any microorganism on CSF tests including cryptococcal antigen test, India ink test, fungus cultures, Gram stain and culture, viral PCR (herpes simplex virus and varicella zoster virus), and tuberculosis PCR.

Bottom Line: Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis.It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid.We treated him with fluconazole at 400 mg/day for 9 months according to the guideline.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea.

ABSTRACT
Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

No MeSH data available.


Related in: MedlinePlus