Intraabdominal cryptococcal lymphadenitis in a patient with systemic lupus erythematosus.
Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.
Kim
Sang-Hyon
SH
Division of Rheumatology, Department of Internal Medicine, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Kim
Sung-Dong
SD
Kim
Hae-Rim
HR
Yoon
Chong-Hyeon
CH
Lee
Sang-Heon
SH
Kim
Ho-Youn
HY
Park
Sung-Hwan
SH
D000328:Adult; D003453:Cryptococcosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008199:Lymphadenitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008643:Mesentery; D009894:Opportunistic Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed