First case of Cryptococcus gattii multilobar pneumonia in Switzerland and associated challenges.
- Colucci N Department of Surgery, Division of Transplant Surgery, Geneva University Hospitals, Geneva, Switzerland / Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy.
- Teasca L Department of Surgery, Division of Transplant Surgery, Geneva University Hospitals, Geneva, Switzerland.
- Riat A Department of Diagnostics, Service of Laboratory Medicine, Bacteriology Laboratory, Geneva University Hospitals, Geneva, Switzerland.
- Lazarevic V Department of Diagnostics, Service of Laboratory Medicine, Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland.
- Van Delden C Department of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Berney T Department of Surgery, Division of Transplant Surgery, Geneva University Hospitals, Geneva, Switzerland.
- Toso C Department of Surgery, Division of Transplant Surgery, Geneva University Hospitals, Geneva, Switzerland.
- Neofytos D Department of Medicine, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
- 2020-09-13
Published in:
- Swiss medical weekly. - 2020
English
BACKGROUND
Cryptococcosis is a frequent complication in immunosuppressed patients, causing mainly central nervous system and lung infection, and leading to increased mortality risk.
CASE PRESENTATION
We present the first documented case in Switzerland of Cryptococcus gattii pneumonia in a kidney-pancreas transplant patient, with a concomitant Pneumocystis jirovecii infection mimicking an immune reconstitution syndrome. Diagnosis of cryptococcal pneumonia was based on a positive serum cryptococcal antigen and confirmed by Grocott’s methenamine silver and periodic acid-Schiff stains on bronchoalveolar lavage fliud. C. gattii was identified with mass spectrometry and antifungal susceptibility testing by microdilution was performed. After an initial successful treatment with liposomal amphotericin-B, flucytosine and tapering of immunosuppression, the patient clinically deteriorated, developing bilateral diffuse ground-glass opacities with consolidations on chest computed tomography. A diagnosis of probable P. jirovecii pneumonia versus an immune reconstitution syndrome was considered. Because of a high titre of Pneumocystis on polymerase chain-reaction testing of bronchoalveloar lavage fluid and high serum b-D-glucan, a diagnosis of probable P. jirovecii pneumonia was made.
CONCLUSION
This case illustrates the potential complications of a cryptococcal infection in immunosuppressed hosts, despite timely diagnosis and appropriate antifungal therapy.
Cryptococcosis is a frequent complication in immunosuppressed patients, causing mainly central nervous system and lung infection, and leading to increased mortality risk.
CASE PRESENTATION
We present the first documented case in Switzerland of Cryptococcus gattii pneumonia in a kidney-pancreas transplant patient, with a concomitant Pneumocystis jirovecii infection mimicking an immune reconstitution syndrome. Diagnosis of cryptococcal pneumonia was based on a positive serum cryptococcal antigen and confirmed by Grocott’s methenamine silver and periodic acid-Schiff stains on bronchoalveolar lavage fliud. C. gattii was identified with mass spectrometry and antifungal susceptibility testing by microdilution was performed. After an initial successful treatment with liposomal amphotericin-B, flucytosine and tapering of immunosuppression, the patient clinically deteriorated, developing bilateral diffuse ground-glass opacities with consolidations on chest computed tomography. A diagnosis of probable P. jirovecii pneumonia versus an immune reconstitution syndrome was considered. Because of a high titre of Pneumocystis on polymerase chain-reaction testing of bronchoalveloar lavage fluid and high serum b-D-glucan, a diagnosis of probable P. jirovecii pneumonia was made.
CONCLUSION
This case illustrates the potential complications of a cryptococcal infection in immunosuppressed hosts, despite timely diagnosis and appropriate antifungal therapy.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.4414/smw.2020.20306
- PMID 32920786
- Persistent URL
- https://sonar.ch/global/documents/53306
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