Fang YF, Cao XH, Yao LY, Cao Q. Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn’s disease: Three case reports. World J Gastroenterol 2023; 29(4): 758-765 [PMID: 36742174 DOI: 10.3748/wjg.v29.i4.758]
Corresponding Author of This Article
Qian Cao, PhD, Chief Doctor, Chief Physician, Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. caoq@zju.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 28, 2023; 29(4): 758-765 Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.758
Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn’s disease: Three case reports
Yan-Fei Fang, Xiang-Han Cao, Ling-Ya Yao, Qian Cao
Yan-Fei Fang, Xiang-Han Cao, Ling-Ya Yao, Qian Cao, Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Fang YF and Cao Q contributed to conceptualization; Fang YF and Cao XH contributed to data collection and manuscript drafting; Fang YF, Cao XH and Yao LY contributed to manuscript revision; All authors have approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Cao, PhD, Chief Doctor, Chief Physician, Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. caoq@zju.edu.cn
Received: August 3, 2022 Peer-review started: August 3, 2022 First decision: November 17, 2022 Revised: December 1, 2022 Accepted: January 3, 2023 Article in press: January 3, 2023 Published online: January 28, 2023
Abstract
BACKGROUND
Corticosteroids and anti-tumor necrosis factor α mAbs are widely used to treat Crohn's disease (CD). However, one disadvantage of this treatment is impairment of normal immune function, leading to an increased risk of infection. Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.
CASE SUMMARY
Here, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment. The patients presented with no or mild respiratory symptoms. Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes. Diagnoses were made using pathological examination and metagenomic sequencing. The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo, and symptoms were resolved. Literature searches were conducted in PubMed, Web of Science, and Embase to retrieve previously reported cases and summarize patient characteristics.
CONCLUSION
The incidence of cryptococcus infection has increased along with immunomodulator use. Clinical vigilance is required for early identification and standardized treatment.
Core Tip: Corticosteroids and anti-tumor necrosis factor α mAbs are commonly used to treat Crohn's disease (CD). However, they may also contribute to an increased risk of opportunistic infections. In this article, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immu-nomodulatory treatment. Pathogen identification mainly depends on pathological examination findings, but metagenomics can serve as an alternative tool. Patients with timely diagnosis generally have a good prognosis, but clinical alerts should be raised in those who are elderly and have comorbidities and dissemination phenotype.
