Pulmonary Cryptococcosis Diagnosed by a Transbronchial Lung Cryobiopsy in a Patient with Rheumatoid Arthritis

Yumi Motokura; Akihiro Ito; Shinya Yokoe; Osamu Iri; Keisuke Nishimura; Shinya Kamiyama; Tadashi Ishida

doi:10.2169/internalmedicine.9764-22

CASE REPORTS

Pulmonary Cryptococcosis Diagnosed by a Transbronchial Lung Cryobiopsy in a Patient with Rheumatoid Arthritis

Yumi Motokura, Akihiro Ito, Shinya Yokoe, Osamu Iri, Keisuke Nishimura, Shinya Kamiyama, Tadashi Ishida

Author information

Yumi Motokura
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Akihiro Ito
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Shinya Yokoe
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Osamu Iri
Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Keisuke Nishimura
Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
Shinya Kamiyama
Department of Laboratory Medicine and Infectious Diseases, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
Department of General Medicine and Infection Diseases, Tsuyama Chuo Hospital, Japan
Tadashi Ishida
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan

Keywords: immunocompromised host, pulmonary cryptococcosis, rheumatoid arthritis, transbronchial lung cryobiopsy

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 4 Pages 583-587

DOI https://doi.org/10.2169/internalmedicine.9764-22

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Abstract

A 77-year-old woman with seronegative rheumatoid arthritis who was being treated with prednisolone (8 mg/day) and methotrexate (12 mg/week) visited our hospital with an 11-day history of a fever and dyspnea. Chest computed tomography showed infiltration in the right lower lobe. A transbronchial lung cryobiopsy (TBLC) showed cryptococcal cells, and bronchoalveolar lavage fluid later showed growth of Cryptococcus neoformans. She was treated with amphotericin B and flucytosine for about four weeks, and the pulmonary shadows improved. The treatment was then changed to fluconazole as outpatient consolidation and maintenance therapy. A rare case of pulmonary cryptococcosis diagnosed by a TBLC is reported.

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