amphotericin-b and Sarcoidosis

Cryptococcus neoformans is a fungal pathogen associated with advanced HIV disease and other disorders associated with immune dysfunction. The pulmonary and the central nervous system are the most common manifestations of the disease. Localised osteomyelitis as the sole manifestation of extrapulmonary disease is rare. Herein, we present five cases of Cryptococcus osteomyelitis as the only manifestation of extrapulmonary disease. We also identified 84 additional cases of isolated cryptococcal osteomyelitis in the literature. Using these data, we have made some general recommendations regarding an approach to treatment of this uncommon clinical entity.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child, Preschool; Cryptococcosis; Cryptococcus neoformans; Female; Hepatitis C; HIV Infections; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Sarcoidosis; Tomography, X-Ray Computed; Young Adult

We reviewed the published reports of skeletal cryptococcosis and added three cases to the fifty-six in the literature. Eight of the patients in the reported cases probably did not have primary skeletal cryptococcosis. The potential toxicity of antifungal drugs in current use and the apparent effectiveness of surgical treatment for patients who only have a single focus of infection in bone, without involvement of other tissues, should be noted. The association of cryptococcosis with other diseases and the difficulty in differentiating purely skeletal involvement from more extensive disease are emphasized.

Topics: Adolescent; Adult; Aged; Amphotericin B; Bone Diseases; Cryptococcosis; Diagnosis, Differential; Female; Flucytosine; Humans; Immunologic Deficiency Syndromes; Male; Sarcoidosis

Topics: Amphotericin B; Candidiasis, Cutaneous; Chronic Disease; Humans; Hypersensitivity, Delayed; Immunity, Cellular; Immunization, Passive; Immunologic Deficiency Syndromes; Sarcoidosis; T-Lymphocytes; Transfer Factor; Wiskott-Aldrich Syndrome

A 51-year-old African-American man with underlying pulmonary, hepatic and splenic sarcoidosis, reported a 3-day history of headache, neck stiffness and photophobia. He was not using medication for chronic sarcoidosis. Physical examination was significant for nuchal rigidity. Lumbar puncture revealed marked eosinophilia in the cerebrospinal fluid, which, on further analysis, demonstrated a positive cryptococcal antigen. HIV antibody and PCR tests were negative. Bronchoscopy and fungal blood cultures were also negative. The patient was started on amphotericin B and flucytosine, with significant clinical improvement. He recovered well without any neurological sequelae and remained symptom-free at 2-week follow-up. Cryptococcal central nervous infections are uniformly fatal if left untreated. Prompt diagnosis and treatment is essential, to prevent the associated high morbidity and mortality.

Topics: Amphotericin B; Antifungal Agents; Eosinophilia; Flucytosine; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Muscle Rigidity; Sarcoidosis; Spinal Puncture

S. dimidiatum (recently reclassified as N. dimidiatum) is a fungus that causes nail and/or superficial skin infection. It may also cause subcutaneous and deep infection, chiefly in immunocompromised patients.. An 87-year-old male treated with oral corticosteroids for sarcoidosis consulted for violaceous cutaneous nodules on the back of his hands. Histopathological examination revealed epithelioid cell granulomas with numerous mycelial filaments and multiple spores. Culture of a biopsy sample resulted in growth of numerous colonies of S. dimidiatum and the patient was treated with intravenous amphotericin B.. This organism is transmitted by direct or indirect contact with contaminated soil or plants. It mainly causes superficial skin and nail infections, and may result in deeper infections on rare occasions. We report a case of subcutaneous infection with S. dimidiatum in an immunocompromised patient (due to general steroid therapy) that was successfully treated using amphotericin B.

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biopsy; Coelomomyces; Dermatomycoses; Diagnosis, Differential; Hand Dermatoses; Humans; Infusions, Intravenous; Male; Opportunistic Infections; Sarcoidosis; Skin

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

HIV infection is the main cause of cryptococcal neuromeningitis but other diseases may be associated with this infection.. We report a case of cryptococcal neuromeningitis in a patient with sarcoidosis and ventriculoatrial shunting. The patient was successfully treated by effective therapy without device withdrawal.. The relationship between cryptococcosis and sarcoïdosis has been already described and may be not fortuitous. However it remains a very rare complication of sarcoidosis. Because of its potential severity (mortality rate of 40%), the diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Blindness; Cerebrospinal Fluid Shunts; Diagnosis, Differential; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Flucytosine; Fludrocortisone; Follow-Up Studies; HIV Seronegativity; Humans; Hydrocephalus; Hydrocortisone; Male; Meningitis, Cryptococcal; Middle Aged; Prednisolone; Sarcoidosis; Time Factors; Treatment Outcome

A 48-year-old man with a history of sarcoidosis was transferred to the Mayo Clinic for evaluation and management of progressive neurologic decline. Two years before admission, he was admitted to a local hospital with mental status changes accompanied by ataxia and severe headache. A diagnosis of pulmonary and central nervous system sarcoidosis was made based on computed tomography of the head, lumbar puncture, and chest radiography. A mediastinoscopy with lymph node biopsy exhibited noncaseating granulomas and negative stains for microorganisms. Prednisone therapy was initiated at 80 mg/day. Clinical improvement was apparent for 13 months during steroid therapy until the slow taper reached a dosage of 20 mg/day. At that time, the patient was readmitted to the local hospital with severe confusion and skin lesions. When intravenous methylprednisolone therapy for presumed central nervous system sarcoidosis did not improve the patient's mental status, he was transferred to the Mayo Clinic. Physical examination of the thighs revealed large, well-marginated, indurated, irregularly bordered, violaceous plaques and rare, umbilicated, satellite papules with central hemorrhagic crusts (Fig. 1A). Superficially ulcerated plaques with a similar appearance to the thigh lesions were coalescing around the lower legs (Fig. 1B). A skin biopsy specimen of the thigh demonstrated abundant numbers of encapsulated organisms and minimal inflammatory response (Fig. 2). Skin, blood, and cerebrospinal fluid cultures confirmed the presence of Cryptococcus neoformans. Amphotericin and flucytosine combination therapy was initiated, and steroid dosages were gradually tapered. A test for human immunodeficiency virus was negative. The patient was dismissed from hospital after a complicated 2-month course resulting in improved mental status but progression of the lower extremity ulcerations as a result of polymicrobial infection.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Flucytosine; Humans; Male; Middle Aged; Opportunistic Infections; Sarcoidosis

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Crohn Disease; Diagnosis, Differential; Female; Granulomatous Disease, Chronic; Humans; Sarcoidosis; Tomography, X-Ray Computed

Topics: Abscess; Adrenal Gland Diseases; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Drainage; Drug Therapy, Combination; Humans; Ketoconazole; Male; Middle Aged; Opportunistic Infections; Rifampin; Sarcoidosis

We give a thorough report on coccidioidomycosis, a systemic mycosis only occurring in the New World. We present microorganism, geography, epidemiology, diagnostic procedures, and therapy. A pilot study on German soldiers trained in the endemic areas of the USA demonstrated by means of a positive skin test that 3.73% of them had been infected.

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Coccidioidin; Coccidioidomycosis; Diagnosis, Differential; Germany, West; Humans; Ketoconazole; Lung; Male; Military Medicine; Sarcoidosis; Skin Tests; Transfer Factor; Tuberculosis, Pulmonary; United States

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Antigens, Fungal; Child; Collagen Diseases; Cryptococcosis; Female; Flucytosine; Hodgkin Disease; Humans; Ireland; Latex Fixation Tests; Male; Middle Aged; Neoplasms; Sarcoidosis; United Kingdom

Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

Topics: Adult; Aged; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Hodgkin Disease; Humans; Immunosuppression Therapy; Kidney Transplantation; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Pneumonia; Sarcoidosis; Transplantation, Homologous

Topics: Adult; Amphotericin B; Candidiasis; Female; Humans; Sarcoidosis

Immunologic studies were performed in two patients with sarcoidosis, who developed cryptococcosis. Polymorphonuclear leukocyte function, complement, and serum antibodies were normal. Both patients had depressed cell-mediated immunity (cmi) to Cryptococcus neoformans and other antigens that persisted after therapy for their infection. These findings suggest that the patients' impaired CMI predisposed them to cryptococcal infection, which complicated their sarcoidosis. Evaluation of sarcoidosis cases should include studies of immune function, and the possibility of a secondary infection should be considered in patients with long-standing sarcoidosis, who develop unexpected changes in their clinical status.

Topics: Amphotericin B; Candida; Cell Count; Cryptococcosis; Cryptococcus neoformans; Dinitrochlorobenzene; Female; Fibula; Flucytosine; Humans; Immunity, Cellular; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; In Vitro Techniques; Middle Aged; Radiography; Sarcoidosis; Skull; T-Lymphocytes

Disseminated cryptococcal infection is described in eight patients, seven of them with verified meningeal involvement. Six of the eight patients were recipients of a renal homograft and submitted to the classical immunosuppressive treatment. Consideration is given to predisposing factors and to problems in the clinical, biological and mycological diagnosis. Some comments are presented on the often disappointing results of antifungal therapy of cryptococcal meningitis.

Topics: Adult; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Female; Flucytosine; Humans; Immunosuppressive Agents; Kidney Transplantation; Lymphoma, Non-Hodgkin; Male; Meningitis; Middle Aged; Postoperative Complications; Sarcoidosis; Transplantation, Homologous

Topics: Adult; Amphotericin B; Bone Marrow; Bone Marrow Cells; Complement Fixation Tests; Female; Histoplasma; Histoplasmosis; Humans; Leukocyte Count; Lung Diseases, Fungal; Lymph Nodes; Male; Penis; Prednisone; Rectum; Sarcoidosis; Sexually Transmitted Diseases; Skin Tests; Sputum; Vulva

Five cases are described in which fear of the possibly hazardous effects of giving amphotericin to patients with kidney disease resulted in death from progressive infection by an amphotericin-sensitive fungus (Cryptococcus neoformans in three cases, Blastomyces dermatitidis in one case, and Histoplasma capsulatum in one case).

Topics: Adrenal Insufficiency; Adult; Amphotericin B; Attitude of Health Personnel; Blastomycosis; Cryptococcosis; Decerebrate State; Drug Prescriptions; Female; Histoplasmosis; Hodgkin Disease; Humans; Kidney Diseases; Lung Diseases, Fungal; Male; Medication Errors; Meningitis; Meningoencephalitis; Mycoses; Phobic Disorders; Sarcoidosis; Spinal Diseases

Topics: Adult; Amphotericin B; Arthritis, Infectious; Female; Humans; Male; Middle Aged; Potassium Iodide; Sarcoidosis; Sporotrichosis

Topics: Adult; Amphotericin B; Cuba; Diagnosis, Differential; Disease Outbreaks; Histoplasmosis; Humans; Lung; Male; Radiography; Sarcoidosis; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Bacteriological Techniques; Biopsy; Brain Abscess; Cerebrospinal Fluid Proteins; Hemiplegia; Humans; Isoniazid; Joint Diseases; Lung Diseases; Male; Meningitis; Nocardia Infections; Polymyxins; Prednisone; Pseudomonas Infections; Sarcoidosis; Skin Diseases; Sporotrichosis; Tetracycline

Topics: Adult; Amphotericin B; Brain; Cryptococcosis; Diagnosis, Differential; Heart Diseases; Humans; Lung; Male; Meningitis; Nephrocalcinosis; Prednisolone; Sarcoidosis; Sepsis

Topics: Adult; Aged; Amphotericin B; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus; Diabetes Complications; Female; Follow-Up Studies; Hodgkin Disease; Humans; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Meningitis; Middle Aged; Sarcoidosis; Silicosis

Topics: Adult; Amphotericin B; Cryptococcosis; Female; Humans; Pleural Effusion; Sarcoidosis; Skin Manifestations

Topics: Amphotericin B; Diagnosis, Differential; Female; Humans; Lung Diseases; Lung Diseases, Fungal; Middle Aged; Occupational Diseases; Sarcoidosis; Sporotrichosis; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Follow-Up Studies; Humans; Iodides; Leg Ulcer; Lung Diseases, Fungal; Male; Occupational Diseases; Ohio; Pneumonectomy; Radiography; Sarcoidosis; Sporothrix; Sporotrichosis; Sputum; Steroids; Tomography; Tuberculosis, Pulmonary; Vegetables

Topics: Adolescent; Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Drug Resistance, Microbial; Female; Humans; Lung Diseases; Middle Aged; Nystatin; Oral Manifestations; Sarcoidosis

Topics: Adrenal Cortex Hormones; Aged; Amphotericin B; Anti-Bacterial Agents; Cryptococcosis; Cryptococcus; Humans; Male; Meningoencephalitis; Middle Aged; Primary Myelofibrosis; Sarcoidosis

Topics: Adult; Amphotericin B; Calcium; Calcium Isotopes; Calcium, Dietary; Carcinoma; Cellulose; Cryptococcosis; Feces; Humans; Hypercalcemia; Intestinal Absorption; Kinetics; Magnesium; Male; Middle Aged; Parathyroid Neoplasms; Phosphates; Phosphorus; Sarcoidosis

Topics: Amphotericin B; Bone Diseases; Cryptococcosis; Diagnosis, Differential; Female; Humans; Middle Aged; Osteolysis, Essential; Ribs; Sarcoidosis

Topics: Adrenal Cortex Hormones; Amphotericin B; Anti-Bacterial Agents; Antitubercular Agents; Ethionamide; Humans; Isoniazid; Meningitis; Meningitis, Viral; Mycoses; Prognosis; Sarcoidosis; Streptodornase and Streptokinase; Streptomycin; Syphilis; Tuberculosis, Meningeal

Topics: Adolescent; Adult; Aged; Amphotericin B; Cryptococcosis; Female; Humans; Male; Middle Aged; Prednisone; Sarcoidosis

Topics: Amphotericin B; Biopsy; Cryptococcosis; Diagnosis, Differential; Drug Therapy; Humans; Lung Diseases; Lymph Nodes; Pathology; Prednisone; Sarcoidosis

Topics: Amphotericin B; Arizona; Coccidioidomycosis; Humans; Leukemia; Leukemia, Lymphoid; Lung Diseases; Lung Diseases, Fungal; Prednisone; Sarcoidosis; Toxicology

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Sarcoidosis

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Humans; Meningitis; Meningitis, Cryptococcal; Sarcoidosis