Acute Respiratory Failure Associated with Cryptococcal Pneumonia and Disseminated Cryptococcosis in an AIDS Patient
A 36-year-old man was admitted to our hospital, with a 30-day history of fever and headache. The patient, a homosexual Mexican, had entered Korea 4 months prior to admission. One year prior to admission, the patient had experienced a mild fever, diarrhea, and 20 kg of weight loss. On admission, this patient's body temperature was 38.5℃, and his blood pressure was 130/80 mmHg. He was alert, and was found to have oral thrush. The patient's breath sounds were clear, and his heart sounds were regular, with no murmur. Hepatomegaly and splenomegaly were noted. Upon neurological examination, neck stiffness and Kernig signs were noted. Upon a cerebrospinal fluid examination, the patient's white blood cell count was 1,580/L, total protein was 26 mg/dL, sugar was 17 mg/dL, and intracranial pressure was 23 cmH2O.\nThe patient was diagnosed with HIV (Human Immunodeficiency Virus) infection via serum Western blotting assay. The total number of CD4+ T lymphocytes and CD8+ T lymphocytes were 7 and 60/L. The patient also had an HIV RNA level of 41,000 copies/mL. Cryptococcus neoformans was isolated on cultures of blood and cerebrospinal fluid.\nOn the day of admission, an initial chest roentgenogram revealed no specific abnormal findings, and the patient was treated with intravenous amphotericin B and ceftriaxone as empirical therapy for possible bacterial and fungal infection.\nOn the patient's 4th day in our hospital, a chest roentgenogram revealed diffuse interstitial infiltrations in both lung field, and computerized tomography revealed diffuse reticulonodular infiltration and a ground-glass appearance in both perihilar areas, suggesting PCP or cryptococcal pneumonia ().\nOn the patient's 6th day in our hospital, bronchoalveolar lavage and transbronchial lung biopsy were conducted via bronchoscopy, and antiretroviral therapy (didanosine, lamivudine, nelfinavir) was initiated. Results of methenamine silver staining of the bronchoalveolar lavage fluid revealed no specific abnormal findings. After the patient's 6th day in our hospital, the patient's breathing difficulties and arterial hypoxemia worsened.\nOn the patient's 9th day in the hospital, his arterial oxygen pressure and saturation level were measured at 32.7 mmHg and 61.6%, and mechanical ventilation was initiated.\nCultures of the patient's blood and CSF samples, obtained at the time of admission, revealed Cryptococcus neoformans. Pathological findings and the special stain results of lung biopsy specimens, obtained at the time of bronchoscopy, also revealed cryptococcal pneumonia (, ).\nThis patient died on his 14th day in our hospital, as the result of acute respiratory failure, associated with cryptococcal pneumonia and disseminated cryptococcosis.