Open AccessCryptococcal pleural infection in a recurrent pleural effusion: a case report
Author(s) -
Wee Audrey Chuan Rui,
Seet Ju Ee,
Venkatalacham Jonathen,
Tan Sze Khen
Publication year - 2018
Publication title -
respirology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.304
H-Index - 9
ISSN - 2051-3380
DOI - 10.1002/rcr2.294
Subject(s) - medicine , pleural effusion , fluconazole , pleural fluid , cryptococcosis , cryptococcus , amphotericin b , pathology , adenosine deaminase , pleural cavity , gastroenterology , dermatology , surgery , antifungal , adenosine , microbiology and biotechnology , biology
Cryptococcal pleural infection is rare with about 50 cases reported. It tends to occur in immunocompromised individuals. We describe a 38‐year‐old male who presented with a lymphocytic exudative right pleural effusion and a raised pleural fluid adenosine deaminase (ADA) level. He was initially treated for pleural tuberculosis, but presented again with worsening pleural effusion 6 weeks later. A thoracoscopic pleural biopsy revealed chronic nodular granulomatous pleuritis with cryptococcal organisms present. The repeat pleural fluid culture was positive for Cryptococcus neoformans . He was started on intravenous amphotericin B and oral flucytosine for 1 week, and then continued on oral fluconazole. He was subsequently diagnosed to have acute myeloid leukaemia. His peripheral blood film showed presence of blast cells (33%), with flow cytometry showing increased myeloblast population. Lymphocytic exudative pleural effusions with raised ADA levels in an immunocompromised patient can be due to opportunistic fungal infections.