J Korean Med Sci.  2005 Dec;20(6):1059-1061. 10.3346/jkms.2005.20.6.1059.

Intraabdominal Cryptococcal Lymphadenitis in a Patient with Systemic Lupus Erythematosus

• Kim SH
• Kim SD
• Kim HR
• Yoon CH
• Lee SH
• Kim HY
• Park SH

• KMID: 2157762
• DOI: http://doi.org/10.3346/jkms.2005.20.6.1059

Abstract

Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.

Keyword

Mesenteric Lymphadenitis; Cryptococcus neoformans; Lupus Erythematosus, Systemic

MeSH Terms

Adult
Cryptococcosis/*etiology/pathology/radiography
Female
Humans
Lupus Erythematosus, Systemic/*complications/immunology
Lymphadenitis/*etiology/pathology/radiography
Mesentery
Opportunistic Infections/etiology/pathology/radiography
Research Support, Non-U.S. Gov't
Retroperitoneal Space
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Abdominal computed tomography (CT) scan shows the multiple conglomerated soft tissue density lesions noted at the mesenteric root, aortocaval space and left paraaortic space; the CT scan also shows the smooth luminal narrowing noted at the third portion of the duodenum, resulting in marked dilatation of the stomach and proximal duodenum (A). Eight weeks later, the follow up abdominal CT scan shows that there is a marked decrease in the sizes and extents of multiple conglomerated lymphadenopathies in the mesenteric root, aortocaval and left paraaortic space, and the previous noted obstruction of the duodenal third portion is resolved (B).

• 

  Fig. 2 Under sonographic guidance, percutaneous needle biopsy was performed on the mesenteric conglomerated lymph nodes, and it shows chronic granulomatous inflammation with focal necrosis and a fungal organism: this is consistent with the cryptococcal infection noted on silver staining (A, ×400) and hematoxylin and eosin staining (B, ×100).

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