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Tuberc Respir Dis > Volume 44(5); 1997 > Article
Tuberculosis and Respiratory Diseases 1997;44(5):1083-1093.
DOI: https://doi.org/10.4046/trd.1997.44.5.1083    Published online January 1, 2001.
Clinical Characteristics of Pulmonary Cryptococcosis.
Doo Seop Moon, , Jeong Soo Yoo, , Chung Mi Kim, , Yeon Soo Kim, , Seung Min Kim, , Kwang Taek Oh, , Jang Won Sohn, , Seok Chul Yang, , Ho Joo Yoon, , Dong Ho Shin, , Sung Soo Park, , Jung Hee Lee, , Shee Young Hahm,
1Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
2Department of Thoracic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
Abstract
BACKGROUND
So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. METHODS: The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. RESULTS: Cryptococcosis occured frequently over sixth decade and the male to female ratio was 3.6:1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnosis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture ,serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. CONCLUSION: Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnostic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.
Key Words: Pulmonary cryptococcosis, Clinical manifestation


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