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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Pulmonary cryptococcosis in childhood systemic lupus erythematosus and Sjogren syndrome overlap: a rare opportunistic infection

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Author(s):
Marques, V. L. S. [1] ; Gomes, R. C. [1] ; Viola, G. R. [1] ; Maia, M. M. [1] ; Durigon, G. S. [2] ; Aikawa, N. E. [1, 3] ; Silva, C. Artur [1, 3]
Total Authors: 7
Affiliation:
[1] Univ Sao Paulo, Fac Med, Pediat Rheumatol Unit, BR-05508 Sao Paulo - Brazil
[2] Univ Sao Paulo, Fac Med, Pediat Infectol Unit, BR-05508 Sao Paulo - Brazil
[3] Univ Sao Paulo, Fac Med, Div Rheumatol, BR-05508 Sao Paulo - Brazil
Total Affiliations: 3
Document type: Journal article
Source: Lupus; v. 22, n. 13, p. 1409-1412, NOV 2013.
Web of Science Citations: 4
Abstract

Meningitis is the main manifestation of cryptococcosis in adult systemic lupus erythematosus (SLE) patients, and other organs and systems, such as the lungs, are rarely affected in this fungal infection. To our knowledge, no case of pulmonary cryptococcosis has been described in the pediatric lupus population. Therefore, we report herein one patient with childhood SLE (C-SLE) and Sjogren's syndrome overlap that presented encapsulated Cryptococcus yeast cells in lung tissue. A 14-year-old girl was diagnosed with C-SLE. At the age of 16 years and 5 months, she presented with fever, cough and dyspnea, without headache, vomiting, and also without signs of meningeal irritation or other clinical manifestations. She was being treated with mycophenolate mofetil, hydroxychloroquine and prednisone. Chest radiography and chest computer tomography showed a single nodule in the left posterior apex and three nodular lesions in the left hemithorax respectively. Bronchoalveolar lavage and transbronchial biopsy were normal and without isolation of bacteria or fungi. Voriconazole was empirically introduced for 21 days. Fifteen days after the first biopsy, she underwent open thoracotomy with surgical left lung biopsy and was diagnosed with pulmonary cryptococcosis. Voriconazole was replaced with oral fluconazole and this antifungal therapy was maintained with improvement of clinical manifestations and without marked alteration of radiological images. In conclusion, we report the first case of pulmonary cryptococcosis in Sjogren's and C-SLE patient with a satisfactory clinical response to antifungal therapy. Fungal infections should be excluded in the presence of lung nodules and etiological identification is required for proper treatment. (AU)

FAPESP's process: 11/12471-2 - Ovarian reserve, antibody anti-corpus luteum and lower genital tract infection in adult women with systemic lupus erythematosus, Behçet's syndrome and Takayasu's arteritis
Grantee:Clovis Artur Almeida da Silva
Support type: Regular Research Grants
FAPESP's process: 08/58238-4 - Autoimmunity in children: investigation of the molecular and cellular bases of early onset of autoimmunity
Grantee:Magda Maria Sales Carneiro-Sampaio
Support type: Research Projects - Thematic Grants