Browse > Article

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)
Publication Information
Tuberculosis and Respiratory Diseases / v.77, no.6, 2014 , pp. 266-270 More about this Journal
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.
Cryptococcus; Cryptococcosis; Rheumatoid Nodule; Arthritis; Rheumatoid;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Anaya JM, Diethelm L, Ortiz LA, Gutierrez M, Citera G, Welsh RA, et al. Pulmonary involvement in rheumatoid arthritis. Semin Arthritis Rheum 1995;24:242-54.   DOI   ScienceOn
2 Gomez Herrero H, Arraiza Sarasa M, Rubio Marco I, Garcia de Eulate Martin-Moro I. Pulmonary rheumatoid nodules: presentation, methods, diagnosis and progression in reference to 5 cases. Reumatol Clin 2012;8:212-5.   DOI
3 Aberg JA, Mundy LM, Powderly WG. Pulmonary cryptococcosis in patients without HIV infection. Chest 1999;115:734-40.   DOI   ScienceOn
4 Kim YS, Lee IH, Kim HS, Jin SS, Lee JH, Kim SK, et al. Pulmonary cryptococcosis mimicking primary lung cancer with multiple lung metastases. Tuberc Respir Dis 2012;73:182-6.   DOI
5 Nunez M, Peacock JE Jr, Chin R Jr. Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. Chest 2000;118:527-34.   DOI   ScienceOn
6 Caporali R, Caprioli M, Bobbio-Pallavicini F, Montecucco C. DMARDS and infections in rheumatoid arthritis. Autoimmun Rev 2008;8:139-43.   DOI
7 Hage CA, Wood KL, Winer-Muram HT, Wilson SJ, Sarosi G, Knox KS. Pulmonary cryptococcosis after initiation of antitumor necrosis factor-alpha therapy. Chest 2003;124:2395-7.   DOI
8 Yoo HG, Yu HM, Jun JB, Jeon HS, Yoo WH. Risk factors of severe infections in patients with rheumatoid arthritis treated with leflunomide. Mod Rheumatol 2013;23:709-15.   DOI
9 Yanagawa N, Sakai F, Takemura T, Ishikawa S, Takaki Y, Hishima T, et al. Pulmonary cryptococcosis in rheumatoid arthritis (RA) patients: comparison of imaging characteristics among RA, acquired immunodeficiency syndrome, and immunocompetent patients. Eur J Radiol 2013;82:2035-42.   DOI
10 Morita Y, Katoh S, Watanabe H, Harada H, Uno E, Satoh M, et al. Rheumatoid nodules of the lung in a patient with palindromic rheumatism. Intern Med 1992;31:951-4.   DOI
11 Song KD, Lee KS, Chung MP, Kwon OJ, Kim TS, Yi CA, et al. Pulmonary cryptococcosis: imaging findings in 23 non-AIDS patients. Korean J Radiol 2010;11:407-16.   DOI   ScienceOn
12 Adelman HM, Dupont EL, Flannery MT, Wallach PM. Case report: recurrent pneumothorax in a patient with rheumatoid arthritis. Am J Med Sci 1994;308:171-2.   DOI
13 Cavazza A, Paci M, Turrini E, Dallari R, Rossi G. Fungus colonisation of pulmonary rheumatoid nodule. J Clin Pathol 2003; 56:636-7.   DOI
14 Winne L, Praet M, Brusselle G, Veys E, Mielants H. Bilateral spontaneous pneumothorax in a patient with pulmonary rheumatoid nodules, secondary infected by Aspergillus. Clin Rheumatol 2007;26:1180-2.   DOI
15 Scully RE, Mark EJ, McNeely WF, Ebeling SH, Phillips LD. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20-1997. A 74-year-old man with progressive cough, dyspnea, and pleural thickening. N Engl J Med 1997;336:1895-903.   DOI