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

Autor(es)

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]}

Afiliação do(s) autor(es)

^[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

• Tipo de documento: Artigo Científico
• Fonte: Lupus; v. 22, n. 13, p. 1409-1412, NOV 2013.
• Citações Web of Science: 4

Resumo

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)

• Processo FAPESP: 11/12471-2 - Avaliação da reserva ovariana, do anticorpo anti-corpo lúteo e da infecção do trato genital inferior de mulheres adultas com lúpus eritematoso sistêmico, síndrome de Behçet e arterite de Takayasu
• Beneficiário: Clovis Artur Almeida da Silva
• Linha de fomento: Auxílio à Pesquisa - Regular
• Processo FAPESP: 08/58238-4 - Autoimunidade na criança: investigação das bases moleculares e celulares da autoimunidade de início precoce
• Beneficiário: Magda Maria Sales Carneiro-Sampaio
• Linha de fomento: Auxílio à Pesquisa - Temático