A case of primary pulmonary cryptococcosis presenting with acute respiratory failure
Yoshinori Matsui1) Shinobu Akagawa1) Akira Hebisawa2) Jyuniti Suzuki1) Masahiro Shimada1) Masahiro Kawashima1) Jyunko Suzuki1) Kimihiko Masuda1) Hirotoshi Matsui1) Atuhisa Tamura1) Hideaki Nagai1) Naohiro Nagayama1) Emiko Toyoda1) Kazuko Machida1) Atsuyuki Kurashima3) Hideki Yotsumoto1)
1)Department of Respiratory Medicine, 2)Department of Pathology, National Hospital Organization, Tokyo National Hospital 3)Second Department of Pulmonary Medicine, Fukujuji Hospital
A 71-year-old previously healthy woman, presented with respiratory failure several days after initiation of cough and fever. A chest X-ray revealed multiple infiltrative shadows with airbronchograms in bilateral middle and lower lung fields. Transbronchial lung biopsy, performed after steroid pulse therapy which induced transient improvement, demonstrated exudative lesions with massive aggregation of histiocytes containing yeast-like fungi in their cytoplasm. Since the test for cryptococcal antigens was positive, a diagnosis of primary pulmonary cryptococcosis was made. Despite intravenous fluconazole injection for aweek, the severity of fungus infiltration increased. The treatment was therefore changed to a combination of intravenous amphotericin B and oral prednisolone, which achieved clinical improvement. In conclusion, in the case of rapidly progressive pulmonary cryptococcosis with widespread exudative lesions, addition of steroid therapy should be considered when antifungal agents alone prove ineffective.
Primary pulmonary cryptococcosis Diffuse infiltration Acute respiratory failure Steroid therapy
Received 平成20年5月19日
JJRS, 46(12): 1039-1044, 2008