A Case of Mediastinal and Pulmonary Cryptococcosis in a 3-Year-Old Immunocompetent Girl

Hee Seon Lee; Hyun Bin Park; Kyung Won Kim; Myung Hyun Sohn; Kyu-Earn Kim; Myung-Joon Kim; Sang Ho Cho

doi:10.7581/pard.2011.21.4.350

Journal List > Pediatr Allergy Respir Dis > v.21(4) > 1033148

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Lee, Park, Kim, Sohn, Kim, Kim, and Cho: A Case of Mediastinal and Pulmonary Cryptococcosis in a 3-Year-Old Immunocompetent Girl

Abstract

Pediatr Allergy Respir Dis 2011;21(4):350-355.

Published online: 20 January 2011

DOI: https://doi.org/10.7581/pard.2011.21.4.350

A Case of Mediastinal and Pulmonary Cryptococcosis in a 3-Year-Old Immunocompetent Girl

Hee Seon Lee, MD¹, Hyun Bin Park, MD¹, Kyung Won Kim, MD, PhD¹, Myung Hyun Sohn, MD, PhD^1,, Kyu-Earn Kim, MD, PhD¹, Myung-Joon Kim, MD, PhD², Sang Ho Cho, MD, PhD³

¹Department of Pediatrics, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea

²Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea

³Department of Pathology, CHA University College of Medicine, Pocheon, Korea

책임저자:손명현, 서울시 서대문구 연세로 250 연세대학교 의과대학 소아과학교실 Tel: 02)2228-2062 Fax: 02)393-9118 E-mail: mhsohn@yuhs.ac

Received 8 September 2011 Revised 6 October 2011 Accepted 7 October 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cryptococcosis is an infrequently recognized infection in children, particularly those who are immunocompetent. The disease is mainly caused by Cryptococcus neoformans, a fungal pathogen that primarily affects the central nervous system (CNS) and lungs. Most reports of children with cryptococcosis are of the CNS or disseminated infections among immunocompromised patients. This report is a case of a 3-year-old immunocompetent girl who presented with intermittent fever and cough; a large mass was found in the right infrahilar area on chest X-ray. Chest computed tomography revealed large conglomerated mediastinal lymph nodes caused by C. neoformans, which was confirmed by the polymerase chain reaction as well as a histological evaluation. The patient improved after a prolonged period of antifungal therapy. This is the only known report of mediastinal and pulmonary cryptococcosis in an immunocompetent child.

Keywords: Mediastinum, Cryptococcosis, Cryptococcus neoformans

References

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Fig. 1.

Chest radiograph showing mediastinal widening and mass-like opacity (arrows) in the right lower lung field.

Fig. 2.

Chest computed tomography scan demonstrating a cavitary lesion in the right lower lobe (A) with lymph node enlargement in the right lower neck (B), mediastinum (C), and hilum (D).

Fig. 3.

Histopathology of the neck lymph node is consistent with Cryptococcus neoformans. Necrotizing granulomatous inflammation (A, H&E, 10; B, H&E, 100). Mucicarmine × × -positive yeasts of variable sizes (arrow) (C, H&E, 400). Yeasts with a thickened × capsule on periodic acid-Schiff stain (arrows) (D, 400). ×

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