Open AccessMissed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review
Author(s) -
Daniel B Chastain,
Andrés F. HenaoMartínez,
Austin C. Dykes,
Gregory M. Steele,
Laura Leigh Stoudenmire,
Geren Thomas,
Vanessa M. Kung,
Carlos FrancoParedes
Publication year - 2022
Publication title -
therapeutic advances in infectious disease
Language(s) - English
Resource type - Journals
eISSN - 2049-937X
pISSN - 2049-9361
DOI - 10.1177/20499361211066363
Subject(s) - cryptococcosis , medicine , immunology , immune system , pneumonia , covid-19 , disease , infectious disease (medical specialty)
SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.