Clinical characteristics of pulmonary sarcoidosis complicated with pulmonary cryptococcus
10.3760/cma.j.issn.0254-9026.2024.11.007
- VernacularTitle:肺结节病合并肺隐球菌病的临床特点分析
- Author:
Jianzhen WENG
1
;
Xiaomao XU
;
Yanming LI
;
Yang JU
Author Information
1. 北京医院呼吸与危重症医学科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Keywords:
Sarcoidosis, pulmonary;
Cryptococcosis;
Pulmonary sarcoidosis;
Glucocorticoids
- From:
Chinese Journal of Geriatrics
2024;43(11):1415-1419
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of patients with pulmonary sarcoidosis complicated by pulmonary cryptococcosis, thereby enhancing the understanding of this clinical scenario.Methods:We report a case of pulmonary sarcoidosis complicated by pulmonary cryptococcosis treated at Beijing Hospital.The patient was diagnosed with stage Ⅱ pulmonary sarcoidosis via CT-guided percutaneous fine needle aspiration lung biopsy.However, during treatment with oral prednisone, a chest CT scan revealed newly developed multiple nodules in the right lower lobe.By considering the patient's medical history, imaging results, cryptococcal antigen(CrAg)levels, and treatment response, a diagnosis of pulmonary sarcoidosis complicated by pulmonary cryptococcosis was established.Additionally, we systematically reviewed the literature on pulmonary sarcoidosis complicated by pulmonary cryptococcosis published before April 2024, focusing on epidemiological characteristics, clinical manifestations, diagnosis, treatment, and prognosis.Results:A total of seven articles were obtained, and nine cases were reviewed in conjunction with this case.Among these, 55.6%(5/9)of the patients were male, with an average age of 51 years, and one-third of the patients were categorized as elderly.The stages of pulmonary sarcoidosis identified were stage Ⅰ and stage Ⅱ.Eight patients(88.9%, 8/9)were receiving glucocorticoids or other immunosuppressants at the time of cryptococcosis diagnosis.In the cases that specified the diagnostic method for cryptococcosis, serum cryptococcal antigen(CrAg)was found to be positive, including in three elderly patients.One patient did not receive antifungal treatment due to the rapid deterioration of his condition.During a follow-up period of at least six months, all patients remained clinically stable, with fluconazole being the most chosen antifungal agent.Conclusions:Although cases of pulmonary sarcoidosis complicated by cryptococcal infection are rare, clinicians should remain vigilant to this possibility.The two conditions may exhibit overlapping clinical manifestations, yet their treatment strategies can be contradictory.Misdiagnosis and delayed diagnosis could result in serious clinical consequences.Serum CrAg testing is particularly useful for diagnosis, especially in elderly patients.
