Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels
Abstract Isolated cryptococcal pleural effusion is rare as the initial clinical presentation in opportunistic cryptococcal infection. We describe a 59‐year‐old male heart transplantation recipient who presented with a mononuclear‐leukocyte‐predominant exudative pleural effusion, with adenosine deami...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-02-01
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| Series: | Respirology Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rcr2.1297 |
| _version_ | 1797295305906978816 |
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| author | Jaehee Lee Bo Eun Park Se Yong Jang Chang Ho Kim |
| author_facet | Jaehee Lee Bo Eun Park Se Yong Jang Chang Ho Kim |
| author_sort | Jaehee Lee |
| collection | DOAJ |
| description | Abstract Isolated cryptococcal pleural effusion is rare as the initial clinical presentation in opportunistic cryptococcal infection. We describe a 59‐year‐old male heart transplantation recipient who presented with a mononuclear‐leukocyte‐predominant exudative pleural effusion, with adenosine deaminase levels (ADA) of 37 IU/L and focal pleural nodularity on computed tomography. A thorough evaluation, including pleural fluid culture, cryptococcal antigen, and histological examination, led to the diagnosis of cryptococcal pleural effusion. Antifungal therapy with fluconazole of 400 mg/day showed clinical and radiological improvement. A literature review identified six cases of cryptococcal pleural effusion that reported pleural fluid ADA levels. All cases, including the present one, involved immunocompromised hosts and exhibited a mononuclear‐leukocyte‐predominant exudate. High pleural fluid ADA levels were observed in approximately half of these cases. The pleural fluid cryptococcal antigen test was an important diagnostic tool for early diagnosis. In an era where immunocompromised hosts are increasing, cryptococcal infection should be considered as a potential aetiology in immunosuppressed patients with an exudative pleural effusion of unknown cause, even if ADA levels are elevated. |
| first_indexed | 2024-03-07T21:44:51Z |
| format | Article |
| id | doaj.art-d117635126db4e278eefe37e4b7cd952 |
| institution | Directory Open Access Journal |
| issn | 2051-3380 |
| language | English |
| last_indexed | 2024-03-07T21:44:51Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Respirology Case Reports |
| spelling | doaj.art-d117635126db4e278eefe37e4b7cd9522024-02-26T01:02:43ZengWileyRespirology Case Reports2051-33802024-02-01122n/an/a10.1002/rcr2.1297Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levelsJaehee Lee0Bo Eun Park1Se Yong Jang2Chang Ho Kim3Department of Internal Medicine Kyungpook National University, School of Medicine Daegu Republic of KoreaDepartment of Internal Medicine Kyungpook National University, School of Medicine Daegu Republic of KoreaDepartment of Internal Medicine Kyungpook National University, School of Medicine Daegu Republic of KoreaDepartment of Internal Medicine Kyungpook National University, School of Medicine Daegu Republic of KoreaAbstract Isolated cryptococcal pleural effusion is rare as the initial clinical presentation in opportunistic cryptococcal infection. We describe a 59‐year‐old male heart transplantation recipient who presented with a mononuclear‐leukocyte‐predominant exudative pleural effusion, with adenosine deaminase levels (ADA) of 37 IU/L and focal pleural nodularity on computed tomography. A thorough evaluation, including pleural fluid culture, cryptococcal antigen, and histological examination, led to the diagnosis of cryptococcal pleural effusion. Antifungal therapy with fluconazole of 400 mg/day showed clinical and radiological improvement. A literature review identified six cases of cryptococcal pleural effusion that reported pleural fluid ADA levels. All cases, including the present one, involved immunocompromised hosts and exhibited a mononuclear‐leukocyte‐predominant exudate. High pleural fluid ADA levels were observed in approximately half of these cases. The pleural fluid cryptococcal antigen test was an important diagnostic tool for early diagnosis. In an era where immunocompromised hosts are increasing, cryptococcal infection should be considered as a potential aetiology in immunosuppressed patients with an exudative pleural effusion of unknown cause, even if ADA levels are elevated.https://doi.org/10.1002/rcr2.1297adenosine deaminasecryptococcal antigencryptococcal pleural effusion |
| spellingShingle | Jaehee Lee Bo Eun Park Se Yong Jang Chang Ho Kim Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels Respirology Case Reports adenosine deaminase cryptococcal antigen cryptococcal pleural effusion |
| title | Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels |
| title_full | Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels |
| title_fullStr | Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels |
| title_full_unstemmed | Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels |
| title_short | Isolated cryptococcal pleural effusion in a heart transplant recipient: A case report and literature review of pleural fluid adenosine deaminase levels |
| title_sort | isolated cryptococcal pleural effusion in a heart transplant recipient a case report and literature review of pleural fluid adenosine deaminase levels |
| topic | adenosine deaminase cryptococcal antigen cryptococcal pleural effusion |
| url | https://doi.org/10.1002/rcr2.1297 |
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