好酸球増多と高IgE 血症を伴った非HIV 患者の播種性クリプトコックス症の1 例

中村 啓二, 三宅 典子, 鑓水 彰, 西田 留梨子, 門脇 雅子, 田辺 公一, 鄭 湧, 下田 慎治, 下野 信行

doi:10.11150/kansenshogakuzasshi.90.819

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タイトル別名

Disseminated Cryptococcosis with Eosinophilia and Elevated IgE in a Non-HIV-infected Patient
症例好酸球増多と高IgE血症を伴った非HIV患者の播種性クリプトコックス症の1例
ショウレイコウサンキュウゾウタトコウIgE ケツショウオトモナッタヒHIV カンジャノハシュセイクリプトコックスショウノ 1レイ

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<p>In general, disseminated cryptococcosis usually occurs among immunocompromised patients, especially those with cell-mediated immunodeficiency, such as HIV-infected patients. We present herein a rare case of an apparently immunocompetent 33-year-old woman who developed disseminated cryptococcal diseases,which included meningitis and pneumonia with eosinophilia, and pulmonary tuberculosis during her disease course. Pneumonia with a diffuse micronodular pattern, immediately followed by meningitis, was diagnosed as disseminated cryptococcosis, because of the presence of yeast-like-fungi demonstrated by transbronchial lung biopsy and a positive cerebrospinal fluid (CSF) culture. In addition, the pneumonia exhibited eosinophilia in the peripheral blood and bronchoalveolar lavage fluid. Re-exacerbation of the pneumonia occurred approximately 3 weeks after onset, along with a sputum culture positive for Mycobacterium tuberculosis.Administration of anti-tuberculosis drugs resulted in recovery from the pulmonary tuberculosis. The treatment of cryptococcal meningitis was initiated using a standard induction regimen ; however, an unrecovered status, highlighted by elevated CSF pressure, persisted. Finally, full recovery was induced by the addition of flucytosine treatment (100mg/kg/day) and repeated daily via lumbar puncture. The allergic condition of this patient may have contributed to the onset of disseminated cryptococcosis. </p>

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感染症学雑誌

感染症学雑誌 90 (6), 819-824, 2016

一般社団法人日本感染症学会

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