Cryptococcal pleural infection in a recurrent pleural effusion: a case report

Cryptococcal pleural infection is rare with about 50 cases reported. It tends to occur in immunocompromised individuals. We describe a 38‐year‐old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treat...

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Bibliographic Details
Published in:Respirology case reports 2018-04, Vol.6 (3), p.e00294-n/a
Main Authors: Wee, Audrey Chuan Rui, Seet, Ju Ee, Venkatalacham, Jonathen, Tan, Sze Khen
Format: Article
Language:English
Subjects:
Acute myeloid leukaemia
Adenosine
Antigens
Biopsy
Blood
Case Report
Case Reports
Chemotherapy
cryptococcal pleural infection
cryptococcosis
Fungal infections
HIV
Human immunodeficiency virus
pleural effusion
Proteins
Stem cells
Tomography
Tuberculosis
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Summary:Cryptococcal pleural infection is rare with about 50 cases reported. It tends to occur in immunocompromised individuals. We describe a 38‐year‐old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treated for pleural tuberculosis, but presented again with worsening pleural effusion 6 weeks later. A thoracoscopic pleural biopsy revealed chronic nodular granulomatous pleuritis with cryptococcal organisms present. The repeat pleural fluid culture was positive for Cryptococcus neoformans. He was started on intravenous amphotericin B and oral flucytosine for 1 week, and then continued on oral fluconazole. He was subsequently diagnosed to have acute myeloid leukaemia. His peripheral blood film showed presence of blast cells (33%), with flow cytometry showing increased myeloblast population. Lymphocytic exudative pleural effusions with raised ADA levels in an immunocompromised patient can be due to opportunistic fungal infections. Recurrent lymphocytic exudative pleural effusion in a previously well young male diagnosed to have cryptococcal pleural infection on thoracoscopic pleural biopsy, treated with intravenous amphotericin and flucytosine, and oral fluconazole. He was subsequently found to have acute myeloid leukaemia and underwent chemotherapy and bone marrow transplantation.
ISSN:2051-3380
2051-3380
DOI:10.1002/rcr2.294