Tuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases.
An 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss. Chest computed tomography (CT) showed diffuse micronodules in random patterns in both lung fields. Liver, skin and bone marrow biopsies showed epithelioid cell granuloma. Polymerase chain reaction of gastric aspirate was positive for Mycobacterium tuberculosis. According to these findings, miliary tuberculosis was suspected and antimycobacterial therapy was initiated. After a 6-month treatment course, chest radiograph showed new multiple nodules in the right middle lung field. Chest CT showed that a right S6 small nodule was increased and new multiple nodules appeared in the right lower lobe. Flexible fiberoptic bronchoscopy was subsequently perfomed. Cytology of the bronchial lavage showed a small number of Periodic acid-Schiff-positive bodies, suggesting Cryptococcus species. Moreover, serum cryptococcal antigen testing was positive. According to these findings, pulmonary cryptococcosis was diagnosed, although the culture was negative. Oral fluconazole therapy was subsequently initiated. After a 6-month treatment course, chest radiograph showed gradual improvement.
Although tuberculosis and cryptococcosis co-infection is relatively rare in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, clinicians should be aware that these infections can co-exist even in non-HIV patients without underlying diseases.
Kakeya H, Izumikawa K, Yamada K, Obata Y, Nishino T, Takazono T, Kosai K, Kurihara S, Nakamura S, Imamura Y, Miyazaki T, Tsukamoto M, Yanagihara K, Tashiro T, Kohno S. Three cases of concurrent infection with Mycobacterium tuberculosis and Cryptococcus neoformans. Intern Med. 2014;53:1685–92. CrossRefPubMed
Manfredi R, Calza L. Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China. Intern. J Infect Dis. 2008;12:438–41.
Thomas R, Christopher DJ, Balamugesh T, James P, Thomas M. Endobronchial pulmonary cryptococcosis and tuberculosis in an immunocompetent host. Singap Med J. 2012;53:e32–4.
Huang CL, Chen CT, SW W, Lin TY. Simultaneous coinfection with Cryptococcus neoformans and Mycobacterium tuberculosis in an adult. Q J Med. 2014;107:223–4. CrossRef
Musabende M, Mukabatsinda C, Riviello ED, Ogbuagu O. Concurrent cryptococcal meningitis and disseminated tuberculosis occurring in an immunocompetent male. BMJ Case Reports. 2016;10:1136.
Aydemir H, Piskin N, Oztoprak N, Celebi G, Tekin IO, Akduman D. Cryptococcus neoformans meningitis in a HIV negative miliary tuberculosis-suspected patient. Mikrobiyol Bul. 2008;42:519–24. PubMed
Diamond RD. Cryptococcus Neoformans. In: Mandell GL, Bennett JE, Dolin R, editors. Bennett’s principles and practice of infectious diseases. 5th edn. London: Churchill Livingstone; 2000. p. 2707–18.
Dohtsu Y, Ishimatsu Y, Takatani H, Minami K, Inoue K, Kohara N, Yanagihara K, Higashiyama Y, Miyazaki Y, Hirakata Y, Kohno S. Clinical studies of sixteen cases with pulmonary cryptococcosis mainly with respect to serum level of cryptococcal antigen. Kansenshogaku zasshi. 2005;79:656–63. CrossRefPubMed
Nagrajan S, Gugnani HC, Kowshik T. Case report. Meningitis due to Cryptococcus neoformans Var. Neoformans serotype AD association with pulmonary tuberculosis. Mycoses. 2000;43:679. CrossRef
Huffnagle GB, Chen GH, Curtis JL, McDonald RA, Strieter RM, Toews GB. Down-regulation of the afferent phase of T cell-mediated pulmonary inflammation and immunity by a high melanin-producing strain of Cryptococcus neoformans. J Immunol. 1995;155:3507–16. PubMed
- Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II