A Case of Pulmonary Cryptococcosis After Kidney-Pancreas Transplantation in Type 1 Diabetes

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  • Nakamura Akira
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine
  • Yasuda Hisafumi
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine
  • Akisaki Taichi
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine
  • Hara Kenta
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine
  • Nagata Masao
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine
  • Yokono Koichi
    Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine

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Other Title
  • 膵腎同時移植後に肺クリプトコッカス症を発症した1型糖尿病の1例
  • 症例報告 膵腎同時移植後に肺クリプトコッカス症を発症した1型糖尿病の1例
  • ショウレイ ホウコク スイジンドウジ イショク ゴ ニ ハイ クリプトコッカスショウ オ ハッショウ シタ 1ガタ トウニョウビョウ ノ 1レイ

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Abstract

A 41-year-old man diagnosed with type 1 diabetes at age 9 and undergoing kidney-pancreas transplantation at age 39, suffered fever and a chest pain in January 2008. Chest X-ray and Computed Tomography (CT) showed multiple nodules with cavities in the lung. Since he had been taking Mycophenolate Mofetil (MMF) , Tacrolimus (FK506) , and Methyl prednisolone (mPSL) , he was suspected of opportunistic infection and admitted in January 15. No microorganella were detected. Blood tests showed WBC 10400/μl, CRP 1.14 mg/dl, ESR26 mm/h, β-glucan <4 pg/ml, serum aspergillus antigen negative, serum candida antigen×2, and serum cryptococcal antigen ×256. These results and high serum cryptococcal antigen titer suggested pulmonary cryptococcosis. MMF was stopped and antifungal drug administration was started immediately. After over one year of antifungal drug, chest X-ray and CT showed reduced lesion of infiltration and gradually decreased serum cryptococcal antigen titer. In conclusion, pancreatic transplantation is useful in type 1 diabetes, but increases the possibility of opportunistic infection, requiring careful follow-up.<br>

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