Cryptococcosis as an opportunistic infection in immunodeficiency secondary to paracoccidioidomycosis.
We describe the case reports of two patients with immunodeficiency secondary to paracoccidioidomycosis (PCM) and opportunistic Cryptococcus neoformans infections. Secondary immunodeficiency likely occurred as a consequence of the intestinal loss of proteins and lymphocytes associated with malabsorption syndrome due to obstructed lymphatic drainage. Both patients had had severe abdominal involvement during the acute PCM disease. Immunological evaluation showed cellular and humoral immunity impairment. Cryptococcosis manifested as relatively well circumscribed lesions: osteolytic lesions of the skull in one patient, and pulmonary nodules in the other. The latter was treated surgically and with amphotericin B, whereas the other was treated with the combination amphotericin-B and flucytosine. Both patients had a good response to treatment with complete regression of the lesions. They have now 2 and 4 years of follow-up with maintenance therapy and no indication of reactivation of the infection. PCM also did not reactivate. The clinical and immunological characteristics of these patients are discussed and compared to the opportunistic C. neoformans infections of AIDS and transplant patients.
Benard
G
G
Immunogenetic and Experimental Transplantation Laboratory, Faculty of Medicine, Universidade de São Paulo, Brazil.
Gryschek
R C
RC
Duarte
A J
AJ
Shikanai-Yasuda
M A
MA
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications* / Q000209:etiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D010229:Paracoccidioidomycosis / Q000150:complications*
D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine