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- W4283169007 abstract "TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Cryptococcus is an opportunistic fungal infection known to cause symptomatic disease in both immunocompromised and immunocompetent patients. While asymptomatic cryptococcal infections have been observed in immunocompetent patients, they have never been identified in the immunocompromised population. We present a case of an asymptomatic pulmonary cryptococcus in an immunocompromised patient. CASE PRESENTATION: 51-year-old female with rheumatoid arthritis on Methotrexate and Tofacitinib was evaluated for an incidental 5 mm pulmonary nodule on commuted tomography (CT). 6-month interval imaging showed diffuse pulmonary nodules and ground glass opacities throughout the right lung. Her only symptoms included an episode of bronchitis that resolved completely with antibiotics 1 month prior to follow-up CT. The significant CT abnormalities prompted a bronchoscopy with transbronchial biopsy which demonstrated bronchiolitis obliterans and rare clusters of histiocytes not organized into distinct granulomas, suggestive of organizing pneumonia. Bronchoalveolar lavage grew less than 5 colonies of cryptococcus neoformans. Biopsy was sent for additional stains demonstrating cryptococcus neoformans. Given her immunocompromised state, fluconazole therapy was initiated. Follow-up imaging showed significant improvement of nodular and ground-glass opacities. DISCUSSION: Cryptococcus is well known to cause symptomatic disease in immunocompromised patients including meningoencephalitis, disseminated disease via hematogenous spread, or pneumonia. While our patient was at risk for a cryptococcal infection due to use of Methotrexate and Tofacitinib, she was asymptomatic. Further investigation was pursued only due to family history and significant CT abnormalities enabling proper diagnosis and treatment. CONCLUSIONS: Cryptococcus should remain on the differential of an immunocompromised patient regardless symptomatology. Bronchoscopy should be considered for appropriate diagnosis and treatment. DISCLOSURE: Nothing to declare. KEYWORD: fungus" @default.
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- W4283169007 date "2022-06-01" @default.
- W4283169007 modified "2023-09-24" @default.
- W4283169007 title "ASYMPTOMATIC PULMONARY CRYPTOCOCCUS IN AN IMMUNOCOMPROMISED PATIENT" @default.
- W4283169007 doi "https://doi.org/10.1016/j.chest.2021.12.143" @default.
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