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Primary abdominal lymphonodular cryptococcosis in children: 2 case reports and a literature review
Chao Chun Zou1, Zhong Sheng Yu, Lan Fang Tang
1The Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China.
Background:
Cryptococcus neoformans is an important opportunistic fungal pathogen that is acquired via the respiratory tract. It causes several clinical syndromes and most commonly presents as meningitis. The establishment of C neoformans infections in immunocompetent individuals could be owing to increased virulence, dose of the organism, or genetically determined differences in the ability to generate a protective immune response against the organism.
Objectives:
The purpose of this study is to report on 2 case studies and a literature review and to discuss the diagnosis and management of primary abdominal lymphonodular cryptococcosis.
Methods:
We conducted 2 case studies and a literature review.
Results:
Two cases of primary abdominal lymphonodular cryptococcosis in childhood were reported herein. The patients suffered from C neoformans without immunoglobulin or lymphocyte abnormalities. The cause of hospitalization of the 2 cases was mainly the persisting fever with or without abdominal pain. Imaging findings indicated dramatic lymphadenopathy and light hepatosplenomegaly. Excision biopsy of the abnormal lymph node demonstrated reactive lymphoid hyperplasia and the presence of C neoformans. The results of nested polymerase chain reaction confirmed the diagnosis of C neoformans.
Conclusion:
This is the first report on C neoformans in the primary abdominal lymph node in children. This report suggests that C neoformans infection should be considered in the differential diagnosis of fever and marked lymphadenopathy, and empirical administration of antifungal agent may be necessary. C neoformans antibody test, polymerase chain reaction assay, fine-needle aspiration biopsy, or surgical excision biopsy is needed in early diagnosis.
Insights
Primary abdominal lymphonodular cryptococcosis caused by Cryptococcus neoformans can occur in children. Early diagnosis through imaging and biopsy is crucial for effective antifungal treatment.
Area of Science:
- Medical Mycology
- Pediatric Infectious Diseases
- Immunocompromised Host Infections
Background:
- Cryptococcus neoformans is an opportunistic fungal pathogen typically acquired through the respiratory tract.
- It commonly causes meningitis but can present with other clinical syndromes.
- Infections in immunocompetent individuals may relate to organism virulence or host immune response differences.
Observation:
- Two pediatric cases of primary abdominal lymphonodular cryptococcosis are presented.
- Patients exhibited persistent fever and/or abdominal pain with significant lymphadenopathy and mild hepatosplenomegaly.
- No immunoglobulin or lymphocyte abnormalities were noted in the affected children.
Findings:
- Excision biopsy revealed reactive lymphoid hyperplasia and the presence of Cryptococcus neoformans.
- Nested polymerase chain reaction confirmed the diagnosis.
- This represents the first report of C. neoformans in primary abdominal lymph nodes in children.
Implications:
- Cryptococcus neoformans infection should be considered in the differential diagnosis of pediatric fever and lymphadenopathy.
- Early diagnosis via imaging, PCR, or biopsy may necessitate empirical antifungal therapy.
- Further research into C. neoformans pathogenesis in immunocompetent hosts is warranted.
