title: [A case of primary pulmonary cryptococcosis presenting with acute respiratory failure].
abstract: A 71-year-old previously healthy woman, presented with respiratory failure several days after initiation of cough and fever. A chest X-ray revealed multiple infiltrative shadows with airbronchograms in bilateral middle and lower lung fields. Transbronchial lung biopsy, performed after steroid pulse therapy which induced transient improvement, demonstrated exudative lesions with massive aggregation of histiocytes containing yeast-like fungi in their cytoplasm. Since the test for cryptococcal antigens was positive, a diagnosis of primary pulmonary cryptococcosis was made. Despite intravenous fluconazole injection for aweek, the severity of fungus infiltration increased. The treatment was therefore changed to a combination of intravenous amphotericin B and oral prednisolone, which achieved clinical improvement. In conclusion, in the case of rapidly progressive pulmonary cryptococcosis with widespread exudative lesions, addition of steroid therapy should be considered when antifungal agents alone prove ineffective.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsui
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
authors.forename: Akira
authors.initials: A
authors.lastname: Hebisawa
authors.forename: Jyuniti
authors.initials: J
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shimada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
authors.forename: Jyunko
authors.initials: J
authors.lastname: Suzuki
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masuda
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Matsui
authors.forename: Atuhisa
authors.initials: A
authors.lastname: Tamura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.forename: Naohiro
authors.initials: N
authors.lastname: Nagayama
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyoda
authors.forename: Kazuko
authors.initials: K
authors.lastname: Machida
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Kurashima
authors.forename: Hideki
authors.initials: H
authors.lastname: Yotsumoto
mesh_terms: D000208:Acute Disease; D000368:Aged; D003453:Cryptococcosis / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000209:etiology*