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• W2895031887 abstract "SESSION TITLE: Chest Infections 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Cryptococcus is an opportunistic infection that affects multiple organs in immunocompromised patients. In solid organ transplant patients, cryptococcus accounts for up to 8% of invasive fungal infections [1]. Infection involving the lung is typically acquired by inhalation of the fungal spores. The overlap of clinical manifestations with other pulmonary infections usually delays diagnosis due to a broad differential diagnoses. CASE PRESENTATION: We present a 62-year-old lady with history of renal cell carcinoma status post nephrectomy and end-stage renal disease status post deceased donor transplant maintained on immunosuppression with mycophenolate, tacrolimus, and prednisone. She initially presented with fevers, rhinorrhea, and cough due to Influenza A virus (IAV) infection for which she was treated with Oseltamivir. However, the chest radiograph revealed a new 2.5 x 1.9 cm right hilar opacity. Computed tomography (CT) scan of the chest confirmed the presence of a necrotizing right hilar mass (Image 1). Subsequent, positron emission tomography (PET) scan showed a hypermetabolic mass concerning for malignancy (Image 2) prompting further evaluation. Bronchoscopy revealed an endobronchial lesion (Image 3) that was suggestive of renal cell carcinoma during rapid onsite evaluation. Sampling of the right hilar mass could not be completed due to poor tolerance of moderate sedation. Cultures from bronchial washing were unrevealing and the final pathology from the endobronchial lesion was inconclusive due to the questionable adequacy of the biopsy specimen. Therefore, repeat bronchoscopy under general anesthesia was performed with fine needle aspiration of the right hilar mass. Surprisingly, the fungal cultures from the initial bronchoscopy procedure grew out Cryptococcus neoformans while awaiting the new biopsy results. Biopsies from the second bronchoscopy confirmed cryptococcal infection and ruled out malignancy. Subsequently, a lumbar puncture was performed to rule out central nervous system involvement while the patient was started on treatment with fluconazole. DISCUSSION: Cryptococcus occur after primary exposure or reactivation of latent infection due to the immunocompromised state. In this case, the patient was immunosuppressed and had IAV infection. Influenza infection usually predisposes patients to secondary bacterial infections. Invasive aspergillosis secondary to IAV has also been reported in the literature; however, reports of cryptococcal infection are sparse [2]. In vivo mice models showed that IAV alters the host immune response to cryptococcus leading to increased proliferation of the fungus and damage to the affected organ [3]. CONCLUSIONS: In immunocompromised patients, maintaining a high index of suspicion for fungal infections causing cavitary lung lesions is vital especially if co-infection with IAV is present. Reference #1: Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 2010; 50:1101e11. Reference #2: Crotty MP, Meyers S, Hampton N, Bledsoe S, Ritchie DJ, et al. Epidemiology, Co-Infections, and Outcomes of Viral Pneumonia in Adults: An Observational Cohort Study. Medicine (Baltimore) 2015; 94(50):e2332. Reference #3: Oliveira LVN, Costa MC, Magalhães TFF, Bastos RW, Santos PC, et al. Influenza A Virus as a predisposing factor for cryptococcosis. Front Cell Infect Microbiol 2017; 7:419. DISCLOSURES: No relevant relationships by Rania Farhat, source=Web Response No relevant relationships by Ghassan Kamel, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Ravi Nayak, source=Web Response No relevant relationships by Pujan Patel, source=Web Response" @default.
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• W2895031887 date "2018-10-01" @default.
• W2895031887 modified "2023-10-03" @default.
• W2895031887 title "HILAR MASS IN THE SETTING OF INFLUENZA A: A CHALLENGING CASE" @default.
• W2895031887 doi "https://doi.org/10.1016/j.chest.2018.08.175" @default.
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