Cryptococcosis is a subacute or chronic mycotic infection caused by cryptococcus neoformans with a special predilection for the lung, skin and central nervous system, but rarely involving the lymphatic system. Recently the authors have experienced two patients with cryptococcosis in volving the liver and lymph nodes. One was 31/4year old male and the other was 11 year old male. The former had suffered from severe abdominal pain since about 1 month ago and high fever developed 10days before admission. On physical examination, jaundice and hepatomegaly were noted with enlarged and tender lymph nodes in the neck and inguinal region. Bone marrow aspiration revealed increased cellularity with eosinophilia. Lymph node and liver biopsy specimens showed mand granulomas including epithelioid cells and Langhan's type giant cells containing numerous cryptococci. The budding cryptococci were also found in the cerebrospinal fluid prepared with India ink. The latter patient was admitted with the chief complaint of high fever and neck mass which had developed one week ago. On physical examination, enlarged lymph nodes were noted in the neck. But hepatomegaly or splenomegaly was not found. Lymph node bisopsy specimen revealed the same findings with the former case. They were treated with Amphotericin B with some improvement, but as the wre discharged because of poor economic condition the were not sufficiently followed up.
Abdominal Pain ; Amphotericin B ; Biopsy ; Bone Marrow ; Central Nervous System ; Cerebrospinal Fluid ; Child* ; Cryptococcosis* ; Cryptococcus neoformans ; Eosinophilia ; Epithelioid Cells ; Fever ; Giant Cells ; Granuloma ; Hepatomegaly ; Humans ; India ; Ink ; Jaundice ; Liver ; Lung ; Lymph Nodes ; Lymphatic System ; Male ; Neck ; Physical Examination ; Skin ; Splenomegaly

Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement. Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.
Abscess ; Endocarditis* ; Female ; Heart Atria ; Humans ; Middle Aged ; Mitral Valve* ; Mortality ; Recurrence ; Sepsis ; Sinus of Valsalva ; Skeleton* ; Staphylococcus epidermidis