Pulmonary cryptococcosis in a patient with ulcerative colitis treated with prednisolone and azathioprine

Authors

DOI:

https://doi.org/10.22516/25007440.429

Keywords:

Inflammatory bowel disease, Ulcerative colitis, Immunosuppression, Opportunistic infections, Pulmonary cryptococcosis

Abstract

Inflammatory bowel disease comprises Crohn’s disease (CD) and ulcerative colitis (UC), the latter being
a chronic disease characterized by diffuse inflammation of the colonic mucosa that affects the rectum and
extends proximally. Its clinical course is intermittent with exacerbations and remissions and its treatment is
generally pharmacological, with steroids, immunomodulators, and anti-tumor necrosis factor inhibitors (TNF), which cause the patient to be in a state of immunosuppression associated, in some cases, with opportunistic infections. The literature describes the occurrence of pulmonary cryptococcosis in patients with human immunodeficiency virus (HIV) infection, in cases associated with drug treatment of patients with CD, as well as with other opportunistic infections such as tuberculosis and herpes. This is one of the first cases of pulmonary cryptococcosis reported in a patient diagnosed with ulcerative colitis, who received step therapy with salicylates, immunomodulators, and biological therapy. The infection was documented clinically, radiologically, and histologically. The patient received the appropriate treatment and had a satisfactory evolution.

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Author Biographies

Robin Germán Prieto Ortíz, Clínica Universitaria Colombia

CEHYD SAS Hospital Central de la Policía

Gustavo Adolfo Reyes Medina, Clínica Universitaria Colombia

Gastroenterólogo

Germán David Carvajal Patiño, Clínica Universitaria Colombia

Gastroenterólogo

 

Edgar José Figueredo Díaz, Seattle VA Hospital/University of Washington

MD, Minimally invasive & critical care surgeon, Seattle, WA, USA

References

Hani AC, Galiano MT, Albis R, Márquez JR, Juliao F. Consenso Colombiano de Enfermedad Inflamatoria Intestinal. Rev Col Gastroenterol. 2012;27(Supl. 1):S1-S44.

Chen LP, Li J, Huang MF, Chen QS, Xia B. Cryptococcus neoformans infection in ulcerative colitis with immunosuppressants. Inflamm Bowel Dis. 2011;17(9):2023-4.

http://doi.org/10.1002/ibd.21619

Pappas PG. Cryptococcal infections in non-HIV-infected patients. Trans Am Clin Climatol Assoc. 2013;124:61-79.

Ye F, Xie JX, Zeng QS, Chen GQ, Zhong SQ, Zhong NS. Retrospective analysis of 76 immunocompetent patients with primary pulmonary cryptococcosis. Lung. 2012;190(3):339-46.

http://doi.org/10.1007/s00408-011-9362-8

Goldman DL, Khine H, Abadi J, Lindenberg DJ, Pirofski La, Niang R, Casadevall A. Serologic evidence for Cryptococcus neoformans infection in early childhood. Pediatrics. 2001;107(5):E66.

http://doi.org/10.1542/peds.107.5.e66

Baddley JW, Dismukes WE. Cryptococcosis. En: Kauffman CA, Pappas PG, Sobel JD, Dismukes WE. Essentials of Clinical Mycology. Nueva York: Springer; 2011. p. 207-226.

Zhang Y, Li N, Zhang Y, Li H, Chen X, Wang S, Zhang X, Zhang R, Xu J, Shi J, Yung RC. Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J. 2012;40(5):1191-200.

http://doi.org/10.1183/09031936.00168011

Suwatanapongched T, Sangsatra W, Boonsarngsuk V, Watcharananan SP, Incharoen P. Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. Diagn Interv Radiol. 2013;19(6):438-46.

http://doi.org/10.5152/dir.2013.13049

Chang YS, Chou KC, Wang PC, Yang HB, Chen CH. Primary pulmonary cryptococcosis presenting as endobronchial tumor with left upper lobe collapse. J Chin Med Assoc. 2005;68(1):33-6.

http://doi.org/10.1016/S1726-4901(09)70129-7

Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 2005;236(1):326-331.

http://doi.org/10.1148/radiol.2361040460

Yu JQ, Tang KJ, Xu BL, Xie CM, Light RW. Pulmonary cryptococcosis in non-AIDS patients. Braz J Infect Dis. 2012;16(6):531-539.

http://doi.org/10.1016/j.bjid.2012.07.004

Singh N, Alexander BD, Lortholary O, Dromer F, Gupta KL, John GT, del Busto R, Klintmalm GB, Somani J, Lyon GM, Pursell K, Stosor V, Muñoz P, Limaye AP, Kalil AC, Pruett TL, Garcia-Diaz J, Humar A, Houston S, House AA, Wray D, Orloff S, Dowdy LA, Fisher RA, Heitman J, Wagener MM, Husain S. Pulmonary cryptococcosis in solid organ transplant recipients: clinical relevance of serum cryptococcal antigen. Clin Infect Dis. 2008;46(2):e12-8.

http://doi.org/10.1086/524738

Rohatgi S, Pirofski LA. Host immunity to Cryptococcus neoformans. Future Microbiol. 2015;10(4):565-581. http://doi.org/10.2217/fmb.14.132

Ali T, Kaitha S, Mahmood S, Ftesi A, Stone J, Bronze MS. Clinical use of anti-TNF therapy and increased risk of infections. Drug Healthc Patient Saf. 2013;5:79-99.

http://doi.org/10.2147/DHPS.S28801

Zhou Q, Hu B, Shao C, Zhou C, Zhang X, Yang D, Li C. A case report of pulmonary cryptococcosis presenting as endobronchial obstruction. J Thorac Dis. 2013;5(4):E170-3.

http://doi.org/10.3978/j.issn.2072-1439.2013.08.40

Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Bijie H, Dzierzanowska D, Klimko NN, Letscher-Bru V, Lisalova M, Muehlethaler K, Rennison C, Zaidi M; Global Antifungal Surveillance Group. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-year analysis of susceptibilities of noncandidal yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol. 2009;47(1):117-23.

http://doi.org/10.1128/JCM.01747-08

Fraison JB, Guilpain P, Schiffmann A, Veyrac M, Le Moing V, Rispail P, Le Quellec A. Pulmonary cryptococcosis in a patient with Crohn’s disease treated with prednisone, azathioprine and adalimumab: exposure to chicken manure as a source of contamination. J Crohns Colitis. 2013;7(1):e11-4.

http://doi.org/10.1016/j.crohns.2012.04.016

Figura 1. En la radiografía de tórax se observan opacidades nodulares con densidad de tejidos blandos, proyectadas a nivel de los lóbulos superior e inferior izquierdo. Fuente: archivo de los autores.

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Published

2020-12-21

How to Cite

Prieto Ortíz, R. G., Reyes Medina, G. A., Carvajal Patiño, G. D., & Figueredo Díaz, E. J. (2020). Pulmonary cryptococcosis in a patient with ulcerative colitis treated with prednisolone and azathioprine. Revista Colombiana De Gastroenterología, 35(4), 545–550. https://doi.org/10.22516/25007440.429

Issue

Vol. 35 No. 4 (2020): Octubre - Diciembre

Section

Case report

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