amphotericin-b and Sarcoidosis--Pulmonary

The fungus Cryptococcus neoformans can cause common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients. But other conditions can be associated with sarcoidosis. Meningoencephalitis is the most common manifestation of this disease. One of the most important neurological complications is the development of intracranial hypertension (ICH), which may result in high morbidity and mortality. We report the case of a patient harboring a ventriculoperitoneal shunt, and having contracted a cryptococcal meningitis as a risk factor for pulmonary sarcoidosis. Brain MRI showed arachnoiditis, with a mass in contact with the right frontal horn. Indian ink staining of the cerebrospinal fluid (CSF) showed positivity that was confirmed by the identification of Cryptococcus neoformans after culture. The evolution was favorable under medical treatment with removal of material. The relationship between sarcoidosis and cryptococcosis, described in the literature is not coincidental but is a rare complication of sarcoidosis of potential severity (40% of mortality). Sarcoidosis is a common systemic disease that may increase host susceptibility to CNS cryptococcal infection without any other signs or symptoms of host immunosuppression. The diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

Topics: Amphotericin B; Antifungal Agents; Arachnoiditis; Carbon; Cerebrospinal Fluid; Coloring Agents; Confusion; Cryptococcus neoformans; Disease Susceptibility; Drug Therapy, Combination; Flucytosine; Humans; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Middle Aged; Prosthesis-Related Infections; Psychomotor Agitation; Sarcoidosis, Pulmonary; Staining and Labeling; Ventriculoperitoneal Shunt

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Drug Therapy, Combination; Flucytosine; Humans; Kidney Diseases; Male; Sarcoidosis; Sarcoidosis, Pulmonary; Treatment Outcome

Cryptoccus neoformans meningitis (CNM) is an opportunistic infection that typically occurs in immunosuppressed patients. Subjects affected by sarcoidosis, a systemic granulomatous disease of unknown cause, are predisposed to CNM because of the impairment of cell-mediated immunity and because of the chronic corticosteroid therapy they frequently receive. Here we report the case of a 38-year-old man who developed CNM as the first clinical manifestation of sarcoidosis. The patient developed CNM even though he was apparently immunocompetent and was not on therapy with either corticosteroid or cytotoxic drugs.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Fatal Outcome; Flucytosine; Humans; Male; Meningitis, Cryptococcal; Opportunistic Infections; Risk Factors; Sarcoidosis, Pulmonary

Lung transplantation has become an acceptable treatment option for many end-stage lung diseases. Pulmonary mycetomas are found in patients with end-stage lung diseases, especially sarcoidosis. The clinical course and long-term outcome of these patients after transplantation remains unknown.. We reviewed retrospectively the pathology reports of the explanted lungs from all lung and heart-lung transplantations performed at our institution between January 20, 1992, and June 26, 2000. Patients were included in our study if mycetomas were present on the specimens. Information on transplant date and type, diagnosis, information on antifungal therapy and fungal infections pretransplant and posttransplant, and clinical course after transplantation was recorded.. Mycetomas were present in 3.0% of transplant recipients (9 of 303 patients). The underlying pulmonary diagnoses were sarcoidosis (six patients), and emphysema, idiopathic pulmonary fibrosis, and pneumoconiosis (one patient each). Seven patients received bilateral lung transplants, one patient received a heart/lung transplant, and one patient received a single lung transplant. Aspergillus was isolated from culture in five patients pretransplant and from five patients posttransplant. Six patients received treatment with itraconazole, or IV or inhaled amphotericin B prior to transplantation. All patients who survived transplantation received posttransplant antifungal therapy. Four patients died in the first month after transplantation. Two patients died at 17 months and 24 months posttransplant, respectively; one patient received a second transplant 30 months later; and two patients are alive and free from fungal infections 17 months and 18 months, respectively, after transplantation. All of the medium-term survivors received lengthy therapy with inhaled and systemic amphotericin B and itraconazole before and after transplantation.. Lung transplant recipients with mycetomas have significantly reduced posttransplant survival. Careful selection of patients and aggressive antifungal therapies before and after transplantation have led to improved outcomes in patients with mycetomas. Additional research is needed to define the best therapeutic strategy for these patients during transplantation.

Topics: Adult; Amphotericin B; Aspergillosis; Female; Follow-Up Studies; Heart-Lung Transplantation; Humans; Itraconazole; Lung; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Mycetoma; Postoperative Complications; Retrospective Studies; Risk Factors; Sarcoidosis, Pulmonary; Survival Rate