TY - JOUR
T1 - Exacerbation of pulmonary cryptococcosis associated with enhancement of Th2 response in the postpartum period
AU - Miyoshi, Shota
AU - Oda, Naohiro
AU - Gion, Yuka
AU - Taki, Takahiro
AU - Mitani, Reo
AU - Takata, Ichiro
AU - Taniguchi, Akihiko
AU - Sato, Yasuharu
AU - Miyahara, Nobuaki
N1 - Funding Information:
We thank Takuro Sakagami (Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan) for measurement of anti-interferon gamma antibody.
Publisher Copyright:
© 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
PY - 2021/8
Y1 - 2021/8
N2 - Cryptococcosis is an invasive mycosis that has become increasingly prevalent in immunocompromised patients. Pregnant women are also one of the risk populations for cryptococcosis. Reversal of Th2 to Th1 response following resolution of immunosuppression during the postpartum period can lead to overt clinical manifestations of a previously silent infection, resembling an immune reconstitution inflammatory syndrome. Here, we report a case of a 30-year-old woman who had an exacerbation of pulmonary cryptococcosis in the postpartum period mimicking an immune reconstitution inflammatory syndrome. In the present case, chest computed tomography showed multiple small nodules on the day of the delivery; however, pulmonary cryptococcosis, which was subclinical during pregnancy, rapidly worsened to mass-like consolidation at one month after the delivery. Pathohistological examination of the lung specimen showed lung parenchyma infiltration with histiocytes and numerous lymphocytes without granulomatous formations, and a small number of yeast-like organisms consistent with Cryptococcus without capillary involvement. Immunohistochemical staining showed predominance of CD3+ cells and CD4+ cells over CD8+ cells. In addition, GATA3+ cells dominated over T-bet + cells. These data suggested exacerbation of pulmonary cryptococcosis associated with enhancement of Th2 response in the postpartum period.
AB - Cryptococcosis is an invasive mycosis that has become increasingly prevalent in immunocompromised patients. Pregnant women are also one of the risk populations for cryptococcosis. Reversal of Th2 to Th1 response following resolution of immunosuppression during the postpartum period can lead to overt clinical manifestations of a previously silent infection, resembling an immune reconstitution inflammatory syndrome. Here, we report a case of a 30-year-old woman who had an exacerbation of pulmonary cryptococcosis in the postpartum period mimicking an immune reconstitution inflammatory syndrome. In the present case, chest computed tomography showed multiple small nodules on the day of the delivery; however, pulmonary cryptococcosis, which was subclinical during pregnancy, rapidly worsened to mass-like consolidation at one month after the delivery. Pathohistological examination of the lung specimen showed lung parenchyma infiltration with histiocytes and numerous lymphocytes without granulomatous formations, and a small number of yeast-like organisms consistent with Cryptococcus without capillary involvement. Immunohistochemical staining showed predominance of CD3+ cells and CD4+ cells over CD8+ cells. In addition, GATA3+ cells dominated over T-bet + cells. These data suggested exacerbation of pulmonary cryptococcosis associated with enhancement of Th2 response in the postpartum period.
KW - Cryptococcosis
KW - GATA3
KW - Immune reconstitution inflammatory syndrome
KW - Postpartum
KW - Th2
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U2 - 10.1016/j.jiac.2021.03.025
DO - 10.1016/j.jiac.2021.03.025
M3 - Article
C2 - 33840597
AN - SCOPUS:85103945981
VL - 27
SP - 1248
EP - 1250
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
SN - 1341-321X
IS - 8
ER -
