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Case Reports
. 2018 Dec 4;18(1):620.
doi: 10.1186/s12879-018-3553-3.

Disseminated cryptococcosis in Crohn's disease: a case report

Natthakit Chavapradit  1 , Nasikarn Angkasekwinai  2
Affiliations
Case Reports

Disseminated cryptococcosis in Crohn's disease: a case report

Natthakit Chavapradit et al. BMC Infect Dis. .

Abstract

Background: Gastrointestinal (GI) cryptococcosis is rarely reported. Most cases were diagnosed during evaluation of comorbid conditions, incidental findings, or postmortem. Here, we present a case of Crohn's disease with gastrointestinal cryptococcosis that resembled exacerbation of Crohn's disease.

Case presentation: A 64-year-old woman with Crohn's disease (CD) was referred to Siriraj Hospital due to worsening of abdominal pain and watery diarrhea for 2 weeks. The dose of immunosuppressive agents was increased for presumed exacerbation of CD. Pathologic examination of tissue obtained from polypoid mass at ileocecal valve and multiple clean-based ulcers at cecum revealed active ileitis and colitis with multiple round shape organisms with capsule, which was compatible with Cryptococcus species. Disseminated cryptococcosis was diagnosed due to gastrointestinal involvement and presumed pulmonary involvement regarding the presence of an oval-shaped cavitary lesion on chest X-ray and computed tomography of the lung. Patient was successfully treated with amphotericin B followed by fluconazole with satisfactory result.

Conclusion: Early diagnosis of gastrointestinal cryptococcosis in Crohn's disease is difficult due to the lack of specific symptoms and sign or mimicking an exacerbation of Crohn's disease. Seeking for other site of involvement in disseminated cryptococcosis including lung or central nervous system as well as detection of serum cryptococcal antigen would be helpful for early diagnosis and management.

Keywords: Crohn’s disease; Cryptococcus neoformans; Gastrointestinal cryptococcosis.

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Conflict of interest statement

Ethics approval and consent to participate

All clinical and demographic data were collected accordance with local ethic committee from Siriraj Hospital Institutional Review Board, Mahidol University, Thailand.

Consent for publication

Written informed consent was obtained from patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Chest radiograph before and after antifungal treatment. a Chest radiograph before treatment with oval-shaped cavitary lesion at the right lower lung field. b Chest radiograph showing lesion improvement at 3 months after start of treatment
Fig. 2
Fig. 2
Colonoscopic finding before and after antifungal treatment. a Colonoscopic finding before treatment reveal polypoid mass at IC valve with multiple clean-based ulcer at cecum. b Colonoscopic finding 10 weeks after treatment show improvement of polypoid mass like lesion at IC valve and ulcer at cecum
Fig. 3
Fig. 3
Pathologic examination of the tissue biopsy for each special stain demonstrated active ileitis and colitis with encapsulated, round-shape yeast form, which is consistent with cryptococcosis. a hematoxylin and eosin (H&E) stain, b Grocott-Gomori’s methenamine silver (GMS) stain, c periodic acid-Schiff (PAS) stain, and d mucicarmine stain
See this image and copyright information in PMC

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