Pulmonary Cryptococcosis Combined with Pulmonary Tuberculosis
Kazuma Kishi1) Sakae Homma1) Atsuko Kurosaki2) Masateru Kawabata1) Eiyasu Tsuboi1) Koji Narui1) Tatsuo Nakatani1) Tadasu Kono3) Noriko Motoi4) Hiroichi Tanimoto5) Koichiro Nakata1)
Divisions of 1)Respiratory Diseases, 2)Diagnostic Radiology, 3)Thoracic Surgery, 4)Pathology, Toranomon Hospital, 5)Tanimoto Medical Clinic
We report a rare combination of pulmonary cryptococcosis and pulmonary tuberculosis in a diabetic patient. A 63-year-old man was admitted to our hospital in January 2002 for evaluation of an abnormal chest radiograph. In 1999, the abnormality had first been detected by mass screening radiography. In 2000, an abnormality in a chest radiograph was again detected in a mass screening, and he visited another hospital. A chest CT scan revealed a cavitating lesion and several nodules in the left lower lobe. Fiberoptic bronchoscopy was performed, but was not diagnostic. The patient was referred to our hospital. He had a history of diabetes mellitus starting in 1984. The chest CT scan revealed solid nodules in the left lower lobe and several micronodules in both upper lobes. Video-assisted thoracoscopic surgery was performed and specimens were obtained from the left S8 and left S1+2. Histologically, cryptococci were detected in the resected left S8. In addition, mycobacterium tuberculosis was cultured from the resected left S1+2. A diagnosis of combined pulmonary cryptococcal and tuberculous infections was made and treatment with itraconazole, isoniazid sodium methansulfonate, rifampicin, and ethambutol hydrochloride was given.
Pulmonary cryptococcosis Pulmonary tuberculosis Diabetes mellitus
Received 平成14年5月29日
JJRS, 41(1): 30-34, 2003