A case of both cryptococcal pneumonia and meningitis with idiopathic CD4+T-lymphocytopenia followed up over a long time

• Published in: Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society Vol. 47; no. 7; p. 608
• Main Authors: Anzai, Fumio, Yamamoto, Akito, Tannai, Noriyuki, Abe, Hideki, Tsuchiya, Kayoko, Kusajima, Kenji, Shimoide, Hisao, Nunomura, Maki
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.07.2009
• Subjects: Cryptococcosis - complications; Follow-Up Studies; Humans; Male; Meningitis, Cryptococcal - complications; Middle Aged; Pneumonia - complications; T-Lymphocytopenia, Idiopathic CD4-Positive - complications
• ISSN: 1343-3490

A 62-year-old man had felt cold-like symptoms for 2 months. He visited a clinic for a health check in late July 1998 and chest X-ray film showed an infiltrative shadow in the left middle and lower lung fields. Next day he had a fever of 38.3 degrees C and felt breathless. Six days thereafter he had a cough, thick head and felt fatigue. Chest X-ray films showed other infiltrative shadows in the bilateral upper lung fields. He worked in a race track and was exposed to pigeons and seabirds at that time. Culture of sputum grew Cryptococcus neoformans. He was admitted and was treated with intravenous antifungal drugs. Cerebrospinal fluid examination revealed positive Indian ink stain for C. neoformans. The CD4 + T-lymphocyte count and CD8 + T-lymphocyte count were 143.4 cells/mm3 and 1288.8 cells/mm3 respectively, but without HIV infection. Cryptococcal pneumonia and meningitis with Idiopathic CD4 + T-lymphocytopenia was diagnosed. After induction therapy, the symptoms improved but abnormal shadows remained on chest X-ray films. Maintenance therapy has been continued at doses of 200 mg/day of fluconazole for 10 years. He has had no symptoms, but the abnormal X-ray shadow has persisted and the CD4 count has remained low during the same period.