Multiple lymphonodular cryptococcosis, cured by 5-fluorocytosine

Area of Science:

• Pediatric Infectious Diseases
• Mycology
• Immunology

Background:

• Cryptococcus neoformans is an opportunistic fungal pathogen that can cause serious infections, particularly in immunocompromised individuals.
• Cervical lymphadenopathy can be a presenting symptom of disseminated cryptococcosis in children.
• Tuberculoid granulomas are a characteristic histopathological finding in some fungal infections.

Observation:

• A 5-year-old boy presented with acute febrile illness and painful cervical lymphadenopathy.
• Chest X-ray revealed enlarged tracheobronchial lymph nodes.
• Lymph node biopsy showed a tuberculoid appearance with epithelioid cells, giant cells, and necrotic zones.

Findings:

• Cryptococcus neoformans was successfully isolated from lymph node biopsy cultures and confirmed by animal inoculation.
• The patient did not tolerate amphotericin B treatment.
• Oral 5-fluorocytosine administration resulted in a rapid and complete clinical recovery.

Implications:

• This case highlights the potential for Cryptococcus neoformans to cause cervical lymphadenitis in children.
• 5-fluorocytosine can be an effective and well-tolerated oral treatment option for pediatric cryptococcosis when amphotericin B is not suitable.
• Early diagnosis and appropriate antifungal therapy are crucial for favorable outcomes in pediatric fungal infections.