Clinical Image
Cryptococcal Lymphadenitis
Department of Radiology, The First Affiliate Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan Province, China
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(B) Doppler ultrasound of the left thoracic wall shows a normal doppler waveform of the intercostal arteries (low peak systolic velocity [27 cm/s] and high resistance index [0.84]). (C) Coronal thoracic maximum intensity projection (MIP) CT image shows hypertrophy of the right superior intercostal arteries (arrows) compared to the left hemithorax. (D) Coronal thoracic MIP CT image shows an unexpected early and prominent contrast enhancement of the right upper lobe vessels (asterisks) due to retrograde filling through the hypertrophied intercostal arteries. (E) Volumetric reconstruction CT image shows the hypertrophy of the posterior right intercostal arteries. (F) Digital subtraction angiogram shows the right intercostal arteries embolization procedure using polyvinyl alcohol particles (300–500 μm in size).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe, Miguel Ángel Gómez-Bermejo, Ana Palomera-Rico" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe" ] 1 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Gómez-Bermejo" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Palomera-Rico" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003575?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000001/v3_202406051404/S0300289623003575/v3_202406051404/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Cryptococcal Lymphadenitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "54" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jia He, Xian-Zheng Tan, Peng Liu" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Jia" "apellidos" => "He" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Xian-Zheng" "apellidos" => "Tan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:4 [ "nombre" => "Peng" "apellidos" => "Liu" "email" => array:1 [ 0 => "lpradiology@163.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Radiology, The First Affiliate Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, Hunan Province, China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 768 "Ancho" => 1533 "Tamanyo" => 200745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Volume-rendered CT (A) and axial unenhanced images (B) showed multiple swollen and partially fused lymph nodes in the hilar (white arrows) and mediastinal (red arrowheads) areas, with the largest one measuring 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm, causing the compression of right and left main bronchus (blue arrows). Axial CT contrast-enhanced image (C) demonstrated slight enhancement of the swollen lymph nodes. At six-month follow-up, chest CT (D and E) showed the shrinkage of lymph nodes and the relief of main bronchus compression. H&E staining (F) demonstrated numerous spherical yeast cells of variable size surrounded by a clear halo (400×), suggesting the diagnosis of cryptococcosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 2-year-old previously healthy boy presented with a 6-day history of intermittent fever documented up to 39<span class="elsevierStyleHsp" style=""></span>°C without shivering and dry cough. Physical examination disclosed multiple swollen lymph nodes in the neck and axilla were mobile, non-stony and tender. Apart from cryptococcal antigen, serological tests were negative for viral, bacterial, mycoplasma, chlamydial infections, and normal for immunological evaluations. Computed tomography (CT) revealed multiple swollen lymph nodes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C). Subsequent cervical lymph nodes histopathology confirmed cryptococcal infection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F). On further questioning, his parents confirmed his recent exposure to pigeon droppings. Then cryptococcal lymphadenitis was diagnosed. He was treated with liposomal amphotericin B, flucytosine and fluconazole. After 6 months, a repeated thoracic CT revealed lymph nodes reduction to non-pathological range (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D and E).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cryptococcosis is usually involved lung or brain, typically in immunocompromised hosts.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Despite its rarity, cryptococcosis may affect immunocompetent individuals, just like this case. The correct diagnosis of cryptococcal lymphadenitis is challengeable as its clinical symptoms and imaging findings are nonspecific. A history of exposure to pigeon droppings and a positive cryptococcal antigen test may assist in diagnosis, but the definite diagnosis was made by histopathology.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> In conclusion, cryptococcal lymphadenitis should be suspected in children with generalized lymphadenopathy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors report no competing interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These authors contributed equally to this work.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 768 "Ancho" => 1533 "Tamanyo" => 200745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Volume-rendered CT (A) and axial unenhanced images (B) showed multiple swollen and partially fused lymph nodes in the hilar (white arrows) and mediastinal (red arrowheads) areas, with the largest one measuring 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm, causing the compression of right and left main bronchus (blue arrows). Axial CT contrast-enhanced image (C) demonstrated slight enhancement of the swollen lymph nodes. At six-month follow-up, chest CT (D and E) showed the shrinkage of lymph nodes and the relief of main bronchus compression. H&E staining (F) demonstrated numerous spherical yeast cells of variable size surrounded by a clear halo (400×), suggesting the diagnosis of cryptococcosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryptococcosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.K. Maziarz" 1 => "J.R. Perfect" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.idc.2015.10.006" "Revista" => array:6 [ "tituloSerie" => "Infect Dis Clin North Am" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "179" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26897067" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated cryptococcosis with multiple and mediastinal lymph node enlargement and lung involvement in an immunocompetent child" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Chen" 1 => "M.J. Zhang" 2 => "X.H. Ge" 3 => "Y.H. Liu" 4 => "T. Jiang" 5 => "J. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Physiol Pathophysiol Pharmacol" "fecha" => "2019" "volumen" => "11" "paginaInicial" => "293" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31993105" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000001/v3_202406051404/S0300289623003629/v3_202406051404/en/main.assets" "Apartado" => array:4 [ "identificador" => "94561" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000001/v3_202406051404/S0300289623003629/v3_202406051404/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003629?idApp=UINPBA00003Z" ]
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