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Evidence of Pulmonary Disseminated Cryptococcosis: Diffuse Multiple Micronodules on Thoracic Computed Tomography

      To the Editor:
      Sperry et al
      • Sperry B.W.
      • Howard E.W.
      • Gitterman S.
      • Panza J.A.
      A case of cryptogenic dyspnea: disseminated cryptococcosis.
      recently reported acute respiratory failure due to disseminated cryptococcal infection, and their pathologic analysis demonstrated Cryptococcus neoformans occluding intra-alveolar spaces and the pulmonary microvasculature. We recently described an extremely rare case
      • Shimoda M.
      • Saraya T.
      • Tsujimoto N.
      • Kurai D.
      • Takizawa H.
      • Goto H.
      Fatal disseminated cryptococcosis resembling miliary tuberculosis in a patient with HIV infection.
      with disseminated cryptococcosis resembling miliary tuberculosis. The patient's serum cryptococcal antigen titer was markedly elevated (1/65,536), and acute respiratory failure progressed over 4 days. After the patient's death, a diagnosis of human immunodeficiency virus infection (CD4 cell count, 12/μL) was made. On the basis of the pathologic findings of Sperry et al, the diffuse multiple faint micronodules on thoracic computed tomography in our case might correspond to the lesions where abundant C. neoformans rapidly occluded intra-alveolar spaces or the pulmonary microvasculature, but did not form granuloma. Thus, it is possible that Sperry et al's case had multiple micronodules on chest x-ray or computed tomography together with a marked elevation of serum cryptococcal antigen titer.

      References

        • Sperry B.W.
        • Howard E.W.
        • Gitterman S.
        • Panza J.A.
        A case of cryptogenic dyspnea: disseminated cryptococcosis.
        Am J Med. 2014; 127: 707-710
        • Shimoda M.
        • Saraya T.
        • Tsujimoto N.
        • Kurai D.
        • Takizawa H.
        • Goto H.
        Fatal disseminated cryptococcosis resembling miliary tuberculosis in a patient with HIV infection.
        Intern Med. 2014; 53: 1641-1644

      Linked Article

      • A Case of Cryptogenic Dyspnea: Disseminated Cryptococcosis
        The American Journal of MedicineVol. 127Issue 8
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          A week of flu-like symptoms was the prelude to a catastrophic course for a 38-year-old African American woman, who had seemed to be in generally good health. She presented with a 2-day history of dyspnea and pleuritic chest pain. Initially, the dyspnea was present only with exertion, but it progressed rapidly to shortness of breath at rest. During the week prior to admission, she also had myalgias, fatigue, sore throat, headache, and a cough that produced yellow sputum.
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