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[Disseminated cryptococcosis mimicking lymphoreticular malignancy: report of one case]
1Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Insights
Disseminated cryptococcosis, a serious fungal infection, was successfully treated in a 10-year-old boy with normal immune function. Early diagnosis and combination antifungal therapy led to a full recovery without recurrence.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Immunology
Background:
- Disseminated cryptococcosis is a rare but severe fungal infection, typically affecting immunocompromised individuals.
- Cryptococcus neoformans is the primary causative agent, often leading to high mortality rates.
Observation:
- A 10-year-old boy presented with fever, weight loss, lymphadenopathy, and hepatosplenomegaly, initially suspected as Hodgkin's disease.
- Lymph node biopsy revealed Cryptococcus neoformans within giant cells and macrophages.
- Blood, CSF, lymph node, bone marrow, and urine cultures confirmed disseminated Cryptococcus neoformans infection with high antigen titers.
Findings:
- Despite presenting with disseminated disease, the patient exhibited normal cellular and humoral immune function.
- Treatment with amphotericin B and 5-fluorocytosine for six weeks resulted in complete clinical resolution.
- The patient remained disease-free during an 18-month follow-up period, indicating successful treatment and recovery.
Implications:
- This case highlights that disseminated cryptococcosis can occur in children with seemingly normal immune systems.
- Prompt diagnosis and aggressive combination antifungal therapy are crucial for favorable outcomes in pediatric disseminated cryptococcosis.
- Further research may be warranted to understand the specific immune mechanisms in such cases and optimize treatment strategies.
Abstract:
Disseminated cryptococcosis is a rare and often fatal disease in children. The majority of cases usually occur in individuals with defective cell-mediated immunity. We herein reported a 10-year-old boy who presented with fever, body weight loss, lymphadenopathy and marked hepatosplenomegaly. He was admitted under the impression of Hodgkin's disease. However lymph node biopsy revealed diffuse infiltration with polynuclear giant cell and macrophage. Numerous ovoid-shaped microorganisms were found in the cytoplasma of those cells. Cultures of blood, CSF, lymph node, bone marrow and urine all yielded cryptococcus neoformans. The cryptococcal antigen titer of blood was 1:1024 X and that of CSF was 1:64 X. The immune function in terms of T-cell number, mitogen responses, serum immunoglobulin and complement was normal. After the diagnosis of disseminated cryptococcosis was established, the patient was treated with amphotericin B (0.6 mg/kg/day) and 5-fluorocytosine (150 mg/kg/day) for 6 weeks. The patient responded to the treatment very well. Lymphadenopathy and hepatospelomegaly disappeared and no more recurrence was found during the follow-up period of more than 18 months.