Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Pulmonary Cryptococcosis That Mimicked Rheumatoid Nodule in Rheumatoid Arthritis Lesion

  • Jang, Dong Won (Department of Internal Medicine, National Medical Center) ;
  • Jeong, Ina (Department of Internal Medicine, National Medical Center) ;
  • Kim, Seon Jae (Department of Internal Medicine, National Medical Center) ;
  • Kim, Seok Won (Department of Internal Medicine, National Medical Center) ;
  • Park, Soo Yeon (Department of Internal Medicine, National Medical Center) ;
  • Kwon, Yong Hwan (Department of Internal Medicine, National Medical Center) ;
  • Jeong, Yeon Oh (Department of Internal Medicine, National Medical Center) ;
  • Lee, Ji Yeon (Department of Internal Medicine, National Medical Center) ;
  • Kim, Bo Sung (Department of Pathology, National Medical Center) ;
  • Kim, Woo-Shik (Department of Thoracic and Cardiovascular Surgery, National Medical Center) ;
  • Joh, Joon-Sung (Department of Internal Medicine, National Medical Center)
  • Received : 2014.07.14
  • Accepted : 2014.08.28
  • Published : 2014.12.31
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Abstract

Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules ( $2.5{\times}2.1{\times}2cm$) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.

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References

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