Rapidly progressive pneumonia caused by Cryptococcus neoformans in the patient of granulomatosis with polyangiitis

Area of Science:

• Infectious Diseases
• Pulmonology
• Rheumatology

Background:

• Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease affecting small to medium-sized blood vessels.
• Patients with GPA, especially those on immunosuppressive therapy, are at increased risk for opportunistic infections.
• Distinguishing infectious pneumonia from GPA exacerbation can be challenging.

Purpose of the Study:

• To report a case of Cryptococcus neoformans pneumonia in a patient with a history of GPA.
• To highlight the diagnostic challenges and successful management of this rare coinfection.
• To emphasize the importance of considering opportunistic infections in immunocompromised patients presenting with respiratory symptoms.

Main Methods:

• Clinical presentation of cough and back pain in a 57-year-old male with GPA.
• Initial computed tomography (CT) revealing mild infiltration and nodules, raising suspicion for GPA exacerbation or bacterial pneumonia.
• Positive serum Cryptococcus neoformans antigen test, worsening chest X-ray findings despite antibiotics, and isolation of C. neoformans from blood and lung tissue confirmed the diagnosis.

Main Results:

• The patient presented with symptoms suggestive of respiratory infection or GPA flare.
• Despite initial antibiotic treatment for suspected bacterial pneumonia, the condition worsened.
• Diagnosis of Cryptococcus neoformans pneumonia was confirmed by positive antigen testing and fungal isolation.
• Treatment with liposomal amphotericin B (L-AMB) and flucytosine (5-FC) was initiated.

Conclusions:

• Cryptococcus neoformans pneumonia can mimic or complicate granulomatosis with polyangiitis.
• Prompt diagnostic workup, including fungal antigen testing and cultures, is essential for accurate diagnosis.
• Antifungal therapy with L-AMB and 5-FC can be effective in treating C. neoformans pneumonia in immunocompromised patients.