Disseminated Cryptococcosis with Rapidly Growing Lung Nodules in an End-stage Renal Disease Patient

• Published in: Internal Medicine Vol. 56; no. 3; pp. 377 - 380
• Main Authors: Inaba, Atsushi, Okada, Akira, Yoshida, Taiko, Itoyama, Satoshi, Nakai, Tatsuro, Hisada, Tetsuya, Takano, Hideki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-01-2017; Japan Science and Technology Agency
• Subjects: Activation; Aged; bilateral pulmonary effusion; Case Report; Cerebrospinal fluid; Cryptococcosis; Cryptococcosis - complications; Cryptococcosis - microbiology; Cryptococcus neoformans; Cryptococcus neoformans - isolation & purification; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Dialysis; disseminated cryptococcosis; End-stage renal disease; Fungi; Hemodialysis; Humans; Internal medicine; Kidney diseases; Lung Diseases, Fungal - complications; Lung Diseases, Fungal - microbiology; Lung nodules; Lungs; Male; multiple lung nodules; Myocardial infarction; Nodules; Pleural fluid; Renal Insufficiency, Chronic - complications; Sputum; Sputum - microbiology; Trachea - microbiology
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.56.7438

A 73-year-old man with type 2 diabetes mellitus and end-stage renal disease was diagnosed with acute myocardial infarction. He required continuous dialysis after percutaneous coronary intervention. Subsequently, multiple nodules were discovered in both lungs for the first time, and Cryptococcus neoformans was isolated from the patient's sputum, blood, bilateral pleural fluid, and cerebrospinal fluid cultures, resulting in a diagnosis of disseminated cryptococcosis. This case represents an invaluable example of disseminated cryptococcosis with rapidly growing lung nodules in a dialysis patient, and illustrates that dialysis causes innate immune disorder and the reactivation of cryptococcosis.