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

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.

Keywords: immunocompromised host; pulmonary cryptococcosis; rheumatoid arthritis; transbronchial lung cryobiopsy.

Figure 1.

Findings of chest radiography and computed tomography (CT). (A) On the day of admission, chest radiography shows an infiltration shadow in the right lower lung field, and (B) CT shows consolidation with an air bronchogram and ground-glass shadow around it in the right lower lobe. (C) Chest radiography and (D) CT show improvement of the infiltration shadow (C: day 21, D: day 26).

Figure 2.

Pathological findings of a transbronchial lung cryobiopsy specimen of a lung infiltration shadow. The red closed arrows indicate the cells of Cryptococcus neoformans. A, C: Hematoxylin and Eosin staining. B, D: Periodic acid-Schiff staining. (A, B ×10; C, D ×20)