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Case Reports
. 2023 Oct 25:13:1258021.
doi: 10.3389/fcimb.2023.1258021. eCollection 2023.

Pleural cryptococcosis diagnosed by pleural biopsy in an immunocompromised patient: a case report

Hongxia Jia  1 , Hongping Liu  1 , Meng Tu  1 , Yan Wang  1 , Xudong He  1 , Guojun Zhang  1
Affiliations
Case Reports

Pleural cryptococcosis diagnosed by pleural biopsy in an immunocompromised patient: a case report

Hongxia Jia et al. Front Cell Infect Microbiol. .

Abstract

Objective: The aim of this study is to report an isolated pleural cryptococcosis with pleural effusion as the only manifestation, confirmed by pleural biopsy in a patient with thymoma combined with myasthenia gravis, who developed pleural effusion of unknown origin after long-term glucocorticoids and tacrolimus therapy.

Methods: Pathological examination of the right pleural biopsy tissue from a patient with unexplained recurrent pleural effusion was implemented. Morphological analysis of the fungal component and metagenomic next-generation sequencing (mNGS) on the pleural tissue were performed.

Results: A biopsy specimen of the right pleura revealed numerous yeast-like organisms surrounded by mucous capsules and Cryptococcus neoformans was detected by mNGS with a species-specific read number (SSRN) of 4, confirming the diagnosis of pleural cryptococcosis. Pleural effusion was eliminated with amphotericin B and fluconazole, and healthy status was maintained at the time of review 1 year later.

Conclusion: Cryptococcosis, manifested by simple pleural effusion, is extremely rare, but when repeated pleural effusion occurs in immunocompromised patients or in patients with malignant tumors, the possibility of cryptococcosis should be treated with high vigilance and pleural biopsy is recommended if necessary in order to confirm the diagnosis.

Keywords: immunocompromised; pleural biopsy; pleural cryptococcosis; pleural effusion; thymoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chest computed tomography at different time points. In the patient with myasthenia gravis after thymoma surgery, a small left pleural effusion was noted on a transverse axial chest CT during regular follow-up (A, B). According to all examinations, the neurologist thought that the chest tightness was due to the recurrence of myasthenia gravis. Methylprednisolone (40mg per day) combined with gamma globulin (400mg per kg) was given. After three days of treatment, the patient's dyspnea worsened. A chest CT was taken again, showed a new bilateral pleural effusion (C, D).
Figure 2
Figure 2
The positron emission tomography was performed 13 days later and showed multiple pleural thickening (A, B) and metabolic activity was found bilaterally with a maximum standard uptake value of 12.5 (B), arrow.
Figure 3
Figure 3
Pathological examination of pleural tissue revealed fungal bodies, which were numerous yeastlike organisms surrounded by mucinous capsules and were between mesothelial cells and histiocytes (A–D), white arrow. Stained by hematoxylin and eosin (A), AB-PAS (B), hexamine silver (C), and mucicarmine (D).
Figure 4
Figure 4
A reexamination of chest CT after 2 months of amphotericin B and fluconazole therapy revealed no pleural effusion (A, B). Follow-up chest CT showed that the patient was still free of pleural effusion 1 year later (C, D).
See this image and copyright information in PMC

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