Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn’s disease: Three case reports

Table 1 Laboratory examination

Case	1	2	3
WBC count (× 109/L)	10.0	9.4	2.5
Neutrophil count (× 109/L)	8.13	8.0	1.6
Platelet count (× 109/L)	305	282	220
Hemoglobin (g/L)	120	139	97
Albumin (g/L)	34.3	42.8	12.0
CRP (mg/L)	23.3	17.4	34.9
ESR (mm/hr)	19	16	14
Tumor markers	Negative	Negative	Negative
T-SPOT.TB	Negative	Negative	Weak positive
EBV IgM	Negative	Negative	-
Cytomegalovirus IgM	Negative	Negative	Negative
HIV	Negative	Negative	Negative
TPPA test	Negative	Negative	Negative

WBC: White blood cell; CRP: C reactive protein; ESR: Erythrocyte sedimentation rate; T-SPOT.TB: T-cell spot of tuberculosis test; EBV: Epstein-Barr virus; IgM: Immunoglobulin M; HIV: Human immunodeficiency virus; TPPA: Treponema pallidum particle agglutination.

Table 2 Clinical characteristics of cryptococcus infection in patients with Crohn’s disease

Ref.	Age/sex	Comorbidity	CD medication	Symptom	Infection site	Treatment	Outcome
Lerner et al[5], 1988	65/M	Ankylosing spondylitis	Prednisone	Calf ulcer	Lungs, skin	AmB, 5FC	Died
Hrnicek et al[6], 2003	51/M	None	IFX, prednisone, MTX, ciprofloxacin	Cough, fatigue, headache, fever, chills	Lungs	Surgery, FLCZ	Recovered
Rehman et al[7], 2008	61/M	None	IFX, prednisone, budesonide, AZA	None	Lungs	AmB, 5FC → FLCZ	Recovered
Osawa et al, 2010[8]	53/M	Silicosis	IFX, prednisone, AZA	Abdominal pain, diarrhea, fever, night sweats, headache	Lungs, GI, CNS	AmB → LAmB, 5FC → FLCZ	Recovered
Sciaudone et al[4], 2011	26/F	None	None	Diarrhea, abdominal pain, weight-loss, headache, cough	Lungs, GI	Surgery, LAmB → FLCZ	Recovered
Hirai et al[9], 2011	39/M	None	IFX	None	Lungs	Surgery	Recovered
Takazono et al[10], 2012	35/M	None	IFX, prednisolone, mesalazine	Fever	Lungs	FLCZ	Recovered
Fraison et al[11], 2013	54/M	Ankylosing spondylitis	ADM, AZA	Fever, anorexia, cough, chest pain, dyspnea, arthralgia, myalgia	Lungs	LAmB, 5FC → FLCZ	Recovered
Wysocki et al[12], 2015	46/M	None	IFX, AZA →ADM →CZP	Abdominal and back pain, fever, headache	Omentum, CNS	LAmB, 5FC	Recovered
Takazono et al[13], 2016	35/M	None	IFX, prednisolone	Fever, fatigue, night sweats	Lungs	FLCZ → ITCZ	Recovered
Zhou et al[14], 2016	66/M	Cryptogenic organizing pneumonia	Prednisone	Dyspnea, cough	Lungs	FLCZ	Recovered
Saad et al[15], 2016	71/M	None	IFX, AZA	Meningitis	CNS	-	-
Vasant et al[16], 2016	74/F	Posterior reversible encephalopathy syndrome	IFX, prednisolone	Headache, confusion, fever, rigor, body ache	CNS	LAmB, 5FC → VRCZ	Died
Lee et al[17], 2017	70/F	Klebsiella pneumoniae and Pneumocystis jiroveci infections	IFX	Pyrexia	CNS	AmB → VRCZ	Died
Chavapradit et al[18], 2018	64/F	None	Prednisolone, AZA, mesalazine	Abdominal pain, diarrhea	Lungs, GI	AmB → FLCZ	Recovered
Maleb et al[19], 2019	45/M	None	Steroid, AZA	Shock, abundance of ascites, fever	Pleural fluid, ascites	FLCZ	Died
Santo et al[20], 2019	23/M	Tuberculosis	IFX, AZA	Fever, headache	Lungs	FLCZ	Recovered
Yeh et al[22], 2021	57/F	Systemic lupus erythematosus	ADM, prednisolone, mesalazine	Pneumonia	Lungs	AmB, 5FC	Recovered
Hussein et al[23], 2021	54/M	None	IFX, prednisolone, MTX	Fever, fatigue, cough	Lungs	FLCZ	Recovered
Yeoh et al[24], 2022	52/F	Autoimmune hepatitis	Prednisolone	Dyspnea, chest pain, cough, lethargy	Lungs	Surgery	Recovered

M: Male; F: Female; IFX: Infliximab; MTX: Methotrexate; AZA: Azathioprine; ADM: Adalimumab; CZP: Certolizumab pegol; GI: Gastrointestinal tract; CNS: Central nervous system; AmB: Aamphotericin B; LAmB: Liposomal amphotericin B; 5FC: 5-fluorocytosine; FLCZ: Fluconazole; ITCZ: Itraconazole; VRCZ: Voriconazole; -: Not reported.