Objective:
To improve the level of
clinical diagnosis and
treatment by analyzing the clinical features and relevant factors of
cryptococcosis neoformans in
patients with
connective tissue disease(CTD).
Methods:
Twelve
patients with CTD and
cryptococcosis neoformans
infection in
Peking University People's
Hospital from January 2010 to April 2021 were retrospectively enrolled. Clinical and
laboratory data,
treatment and outcome were collected and analyzed. Independent sample t-test or
Rank-sum test was used.
Results:
The age of the
patients ranged from 18 to 85 years old(mean 51 years old), all of whom were
female. None of them were exposed to
pigeons and their
feces. Of the 12
patients, 3
patients suffered from
rheumatoid arthritis, 7
patients had
systemic lupus erythematosus, 1
patient was diagnosed with primary Sj?gren 's
syndrome, and 1
patient was diagnosed as
undifferentiated connective tissue disease. Four cases were
cryptococcal meningitis, 8 were pulmonary
cryptococcosis. None of the 12
patients had immunodeficiency
virus infection. All 12
patients were given
glucocorticoid alone or combined with immunosuppressive or
biological agents. All were detected with positive
cryptococcus neoformans antigen in
serum; 6 got
lumbar puncture, 2 cases were positive for
ink stain,
cerebrospinal fluid (CSF)
culture were positive in 2, in whom 3 had high
intracranial pressure, in which the highest one was more than 600 mmH 2O (1 mmH 2O=0.009 8 kPa); 7 cases underwent
lung biopsy. Among these
patients, all were positive for
cryptococcosis neoformans in
lung tissue pathological examination; 6 had the number of peripheral
lymphocytes less than 1.0×10 9/L, and 2 were detected for the number of CD4 +
T cell, which was significantly decreased. As for the initial anti-fungal
drug therapy, all cases were treated with
fluconazole intravenously; 2 were treated with combined
amphotericin, 1 was treated with combined fluorocytosine, 1 was treated with
amphotericin and fluorocytosine. Then oral flu-conazole was prescribed as sequential
therapy. The whole treatmentcourse ranged from 4 to 21 months. Eleven
patients were cured, and 1 was relieved.
Conclusion:
Patients with
connective tissue disease complicated with
cryptococcus neoformans infection have atypical clinical symptoms.
Treatment with immunosuppressive
drugs and
glucocorticoids are related causes.
Patients with decreased peripheral
blood lymphocytes, especially CD4 +
T cell, are more susceptible to
infection.
Early diagnosis and timely
treatment are the key to improve the
prognosis and
cure of the
disease.