Cryptococcal Pneumonia: An Unusual Complication in a COVID-19 Patient
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Published on: December 19, 2020
Jan Štingl1, Julie Hylmarová1,2, Martina Lengerová1,3
1Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
Abstract:
Cryptococcal superinfection is a rare but potentially fatal complication, especially if its detection and subsequent treatment are delayed. Histopathological findings of pulmonary parenchyma from a deceased patient with these complications were acquired. Quite interestingly, only a minimal inflammatory reaction could be seen in an individual with no previously known immune suppression, indicating a disturbance of the immune system. This finding was well in concordance with the described changes in cellular immunity in COVID-19. We report the case of a 60 year old male with critical coronavirus disease 2019 (COVID-19) complicated by cryptococcal pneumonia and multiorgan failure. Both X-ray and CT scans revealed lung infiltrates corresponding with COVID-19 infection early after the onset of symptoms. Despite receiving standard treatment, the patient progressed into multiple organ failure, requiring mechanical ventilation, circulatory support, and haemodialysis. Cryptococcus neoformans was detected by subsequent BAL, and specific antifungal treatment was instituted. His clinical status deteriorated despite all treatment, and he died of refractory circulatory failure after 21 days from hospital admission. Histopathological findings confirmed severe diffuse alveolar damage (DAD) caused by COVID-19 and cryptococcal pneumonia. Timely diagnosis of cryptococcal superinfection may be challenging; therefore, PCR panels detecting even uncommon pathogens should be implemented while taking care of critical COVID-19 patients.
Insights
A rare cryptococcal pneumonia superinfection complicated critical COVID-19 in an immunocompetent patient. Despite treatment, the patient experienced multiorgan failure and died, highlighting diagnostic challenges.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cryptococcal superinfection is a rare but severe complication, particularly when diagnosis and treatment are delayed.
- Critical COVID-19 can lead to immune dysregulation, potentially increasing susceptibility to opportunistic infections.
- Pulmonary involvement in COVID-19 can present with infiltrates, complicating the diagnosis of co-infections.
Purpose of the Study:
- To report a case of cryptococcal pneumonia complicating critical COVID-19 in a patient with no prior immune suppression.
- To highlight the diagnostic challenges and potential severity of cryptococcal superinfection in critically ill COVID-19 patients.
- To emphasize the importance of considering uncommon pathogens in severe COVID-19 cases.
Main Methods:
- Case report of a 60-year-old male with critical COVID-19.
- Utilized X-ray and CT scans for initial lung infiltrate assessment.
- Diagnosed *Cryptococcus neoformans* via bronchoalveolar lavage (BAL) and initiated antifungal treatment.
- Performed histopathological examination of pulmonary parenchyma.
Main Results:
- The patient presented with lung infiltrates consistent with COVID-19 and progressed to multiorgan failure.
- Despite standard treatment and subsequent antifungal therapy, the patient's condition deteriorated.
- Histopathology confirmed diffuse alveolar damage (DAD) from COVID-19 and cryptococcal pneumonia.
- Minimal inflammatory response was noted despite the severe infection.
Conclusions:
- Cryptococcal superinfection can occur in critically ill COVID-19 patients, even without known immune suppression.
- Timely diagnosis of cryptococcal superinfection is challenging and crucial for patient outcomes.
- Implementation of PCR panels for detecting uncommon pathogens is recommended for critical COVID-19 care.
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