Journal List > J Korean Radiol Soc > v.16(1) > 1137479

Lim and Oh: The radiological manifestation of cryptococcosis

Abstract

Crytococcosis is an uncommon mycotic disease caused by Cryptococcus neoformans, with a special affinity forthe respiratory and central nervous system, and less frequently affecting liver, spleen, skin, lymph nodes andkidney. It was first described by Busse in 1894, and since then the occurrences had been world-widely reportedwith increasing incidence. The outcome of the disease may be fatal when the treatment is delayed. The main portalof entry is via the respiratory tract, and the pulmonary menifestations are not specific but quite varying, thatsolitary or multiple poulmonary masses, nodular or reticular infiltrations, cavity formation, lymphadenopathy orplerual effusion can be detected on the chest x-ray films simulating many other diseases. Authors analyzed andevaluated 16 cases of confirmed cryptococcosis, and interesting clinical and radiologic features that definitelydiffered from most of the other reports were notable as follows; 1. The incidence of cryptococcosis ranks3rd(4.3%) among deep mycoses, next to moniliasis and aspergillosis. 2. 15 of 16 patients are in the period ofpediatric age under 16 year old of age. 3. There are no remarkable underlying diseases or predisposing factorsencoutered in all of the 16 cases. 4. Besides the predominating meningeal irritating symptoms, the involvement ofthe reticuloendothelial system, i.e., lymph nodes, liver and spleen are notable. 5. Characteristic features of thepulmonary cryptococcosis are; a) 8 of 10 cases have marked hilar and paratracheal lymph nodes enlargement. b) Noneof the cases reveals solitary pulmonary mass, cavity formation or pleural effusion. c) The lung infiltrations aremainly reticular or coarse nodular pattern. d) The infiltrations are diffusely distributed on entire lung field,rather than the predilection for the lower lobe. 6. Similarly to most of the other reports, the central nervoussystem involvement are most frequent(12 of 16 cases). 7. The combined therapy with Amphotericin B and 5-FC wasdone in all patients and resulted good improvement in 13 of 16 cases.

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