Pediatr Allergy Respir Dis.  2011 Dec;21(4):350-355.

A Case of Mediastinal and Pulmonary Cryptococcosis in a 3-Year-Old Immunocompetent Girl

• Lee HS
• Park HB
• Kim KW
• Sohn MH
• Kim KE
• Kim MJ
• Cho SH

Abstract

Cryptococcosis is an infrequently recognized infection in children, particularly those who are immunocompetent. The disease is mainly caused by Cryptococcus neoformans, a fungal pathogen that primarily affects the central nervous system (CNS) and lungs. Most reports of children with cryptococcosis are of the CNS or disseminated infections among immunocompromised patients. This report is a case of a 3-year-old immunocompetent girl who presented with intermittent fever and cough; a large mass was found in the right infrahilar area on chest X-ray. Chest computed tomography revealed large conglomerated mediastinal lymph nodes caused by C. neoformans, which was confirmed by the polymerase chain reaction as well as a histological evaluation. The patient improved after a prolonged period of antifungal therapy. This is the only known report of mediastinal and pulmonary cryptococcosis in an immunocompetent child.

Keyword

Mediastinum; Cryptococcosis; Cryptococcus neoformans

MeSH Terms

Central Nervous System
Child
Cryptococcosis
Cryptococcus neoformans
Fever
Humans
Immunocompromised Host
Lung
Lymph Nodes
Mediastinum
Polymerase Chain Reaction
Preschool Child
Thorax

Figure

• 

  Fig. 1. Chest radiograph showing mediastinal widening and mass-like opacity (arrows) in the right lower lung field.

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  Fig. 2. Chest computed tomography scan demonstrating a cavitary lesion in the right lower lobe (A) with lymph node enlargement in the right lower neck (B), mediastinum (C), and hilum (D).

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  Fig. 3. Histopathology of the neck lymph node is consistent with Cryptococcus neoformans. Necrotizing granulomatous inflammation (A, H&E, 10; B, H&E, 100). Mucicarmine × × -positive yeasts of variable sizes (arrow) (C, H&E, 400). Yeasts with a thickened × capsule on periodic acid-Schiff stain (arrows) (D, 400). ×

Reference

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