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Cryptococcal Pneumonia in Multiple Myeloma: A Case Report.

Dustin Epstein1, Joanna Herrera1, Tiffany Nong2

  • 1Oncology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.

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|January 13, 2025
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Summary
This summary is machine-generated.

Multiple myeloma patients are susceptible to Cryptococcus infections. Early fluconazole treatment resolved pulmonary nodules and improved symptoms in a relapsed multiple myeloma patient.

Keywords:
cryptococcal pneumoniaimmunocompromised patientlung nodulesmultiple myelomarenal impairment

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Area of Science:

  • Infectious Diseases
  • Hematology
  • Oncology

Background:

  • Multiple myeloma (MM) patients face increased infection risk due to disease-related immunosuppression and treatments.
  • Cryptococcus, an opportunistic fungal pathogen, can cause severe pulmonary and central nervous system infections in immunocompromised individuals.

Observation:

  • A 75-year-old male with relapsed MM presented with pulmonary nodules and later, abdominal pain, chills, and fatigue.
  • Initial MM treatment adjustments improved hematologic parameters but not pulmonary findings.
  • Subsequent symptoms of cough and sore throat, coupled with positive cryptococcal antigen titers, suggested a fungal etiology.

Findings:

  • Despite negative cerebrospinal fluid analysis, oral fluconazole was initiated due to clinical suspicion and patient frailty.
  • The patient experienced symptomatic improvement and resolution of pulmonary nodules on CT after fluconazole therapy.

Implications:

  • This case highlights the importance of considering Cryptococcus in MM patients with pulmonary infiltrates, even with atypical presentations.
  • Prompt diagnosis and treatment of fungal infections are crucial for managing immunocompromised patients and improving outcomes.
  • Non-invasive diagnostic approaches, like monitoring clinical response to empiric treatment, can be valuable in frail patients.