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Pulmonary alveolar proteinosis complicated by pulmonary and intracranial cryptococcal infection: A case report
Chun-Xing Ye1, Huan-Qing Lin1, Zi-Ran Wang2
1Department of Respiratory Medicine, Longgang Central Hospital, Shenzhen, Guangdong Province, China.
Rationale:
Pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease. Superimposed opportunistic Cryptococcus gattii infection can significantly complicate clinical management.
Patient Concerns:
A 34-year-old male patient presented to the respiratory department with a paroxysmal cough for 2 months.
Diagnoses:
Typical computed tomography manifestation and lung biopsy were consistent with PAP. Culture of lung lavage fluid, cerebrospinal fluid, and targeted next-generation sequencing of lung tissue revealed Cryptococcus infection.
Interventions:
Amphotericin B, fluconazole, and flucytosine were used for induction therapy. Right lower lobectomy combined with postoperative voriconazole was continued.
Outcomes:
The CSF cryptococcal antigen titer has declined, and brain MRI shows a reduction in lesions. The clinical course is now stable and improving.
Lessons:
Patients with PAP may have relatively rare opportunistic infections. Multifaceted examinations are very necessary for the diagnosis of C. gattii. During the treatment of C. gattii, great attention should be paid to possible adverse reactions such as liver and kidney damage and thrombosis.
Insights
Pulmonary alveolar proteinosis (PAP) can rarely present with Cryptococcus gattii infection. Early diagnosis and multifaceted treatment are crucial for managing this rare opportunistic infection in PAP patients.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease.
- Opportunistic Cryptococcus gattii infection can complicate PAP management.
- This case highlights a rare co-infection scenario.
Purpose of the Study:
- To report a case of Pulmonary Alveolar Proteinosis (PAP) with superimposed Cryptococcus gattii infection.
- To emphasize the diagnostic challenges and treatment strategies for this rare co-infection.
- To underscore the importance of comprehensive diagnostic approaches.
Main Methods:
- A 34-year-old male with a 2-month cough presented with PAP.
- Diagnosis confirmed by CT scan, lung biopsy, and lavage fluid/CSF cultures.
- Next-generation sequencing of lung tissue identified Cryptococcus infection.
Main Results:
- Induction therapy included Amphotericin B, fluconazole, and flucytosine.
- Surgical intervention (right lower lobectomy) and voriconazole were administered postoperatively.
- Patient showed clinical improvement with declining CSF cryptococcal antigen and reduced brain lesions on MRI.
Conclusions:
- PAP patients are susceptible to rare opportunistic infections like C. gattii.
- Multifaceted diagnostic examinations are essential for identifying C. gattii.
- Close monitoring for adverse reactions (liver/kidney damage, thrombosis) during C. gattii treatment is vital.
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