Prednisolone
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Prednisolone Trichosporon mycotoxinivorans and Cryptococcus neoformans co-infection in lung: case report
A 70-year-old woman developed Trichosporon mycotoxinivorans and Cryptococcus neoformans co-infection in the lung during treatment with prednisolone. The woman was hospitalised for hepatic encephalopathy and acute cholangitis. Previously, she had been diagnosed with primary sclerosing cholangitis and primary biliary cirrhosis. She did not have any history of dust exposure or smoking. She also had chronic bronchitis, Sjogren’s syndrome and rheumatoid arthritis, and had been receiving prednisolone, 8 mg/day [route not stated] along with ursodeoxycholic acid for 10 years. On physical examination, abdominal tenderness and jaundice of the skin were noted, but crackles were not audible on chest auscultation. Chest radiography revealed multiple nodules in the lower and right middle lung fields. Chest CT revealed multiple masses and nodules in the lower and right middle lobes. Over a period of 2 months, the masses and nodules increased. Laboratory findings showed elevations in the levels of hepatic enzymes, C-reactive protein, β-D glucan and Cryptococcus antigen. She underwent bronchoscopy with bronchial lavage, brushing and a transbronchial lung biopsy on the right lung nodules. By using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDITOF MS), C. neoformans and T. mycotoxinivorans were identified after 8 and 3 days of culture in brushing specimens, respectively. The analysis on the MALDI BioTyper system revealed accurate T. mycotoxinivorans identification. The pathological specimens of the lung nodules revealed yeast-like pathogens with capsules and epithelioid granulomas after Grocott, Hematoxylin and Eosin and periodic acid-Schiff staining. In these specimens, distinguishing between Cryptococcus and Trichosporon was difficult. Thus, a diagnosis of co-infection of the lung with C. neoformans and T. mycotoxinivorans was considered [duration of treatment to reaction onset not stated]. The woman was treated with fluconazole. After 5 months of this treatment, her lung shadows did not increase as seen on chest radiography. However, she died due to liver failure. Sadamatsu H, et al. A rare case of Trichosporon mycotoxinivorans and Cryptococcus neoformans co-infection in lung. Journal of Infection and Chemotherapy 26: 838-842, 803498552 No. 8, Aug 2020. Available from: URL: http://doi.org/10.1016/j.jiac.2020.03.002
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Reactions 29 Aug 2020 No. 1819
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