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首页> 外文期刊>Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG >Cryptococcosis and sarcoidosis: strange bed-fellows. A report of five cases.
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Cryptococcosis and sarcoidosis: strange bed-fellows. A report of five cases.

机译：隐球菌病和结节病：奇怪的床哥们。五例报告。

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BACKGROUND AND AIM: Sarcoidosis is known to predispose to cryptococcal infection. In this case series, variations in presentation, diagnostic dilemmas and responses to treatment are highlighted. METHODS: Of several hundred patients referred to the sarcoidosis clinic at The Prince Charles Hospital, Brisbane and to the private clinic of the co-author between 1990 and 2002, five subsequently developed cryptococcal infections as a complication of sarcoidosis. All five subjects were treated by the co-author (RKAA). A review of the literature was also performed. RESULTS: Cryptococcal infection occurred in 4 patients with sarcoidosis being treated with steroids and one patient who was not on treatment. All responded to antifungal therapy. Cryptococcosis was diagnosed by transbronchial (2), bronchial (1) and cutaneous (2) biopsies. Fluconazole was used in those with pulmonary infections but not in cutaneous disease where excision sufficed. One patient with pulmonary cryptococcosis from immunosuppressants also developed a nocardial brain abscess. CONCLUSIONS: Our series of patients with sarcoidosis and cryptococcal infections is unique in Australia. Although an unusual infection, cryptococcosis should always be considered in patients with sarcoidosis as it may be overlooked particularly in the lungs and can be fatal if untreated. Further immune dysregulation through steroid use may contribute significantly to the disease manifestations. Understanding why cryptococcosis and not other infections is more common in patients with sarcoidosis may reveal more about the mechanisms of granuloma formation and the nature of sarcoidosis itself.
机译：背景与目的：结节病易患隐球菌感染。在本案例系列中，突出显示了表现形式，诊断难题和对治疗的反应。方法：在1990年至2002年间，数百名患者被转诊至布里斯班王子查尔斯医院结节病诊所，并转为合著者的私人诊所，其中五名患者随后发展为隐球菌病并发结节病。这五位受试者均由合著者（RKAA）治疗。还对文献进行了回顾。结果：4例结节病患者接受类固醇治疗后发生隐球菌感染，另一例未接受治疗的患者发生隐球菌感染。所有的人都对抗真菌治疗有反应。通过经支气管活检（2），支气管活检（1）和皮肤活检（2）诊断出隐球菌病。氟康唑用于肺部感染的患者，但在切除足够的皮肤疾病中不使用。一名来自免疫抑制剂的肺隐球菌病患者也出现了脑部脓肿。结论：我们的结节病和隐球菌感染患者系列在澳大利亚是独一无二的。尽管是不寻常的感染，但在结节病患者中应始终考虑隐球菌病，因为它可能会被忽略，尤其是在肺部，如果不加以治疗可能会致命。通过使用类固醇的进一步免疫失调可能会大大促进疾病的表现。了解结节病患者为什么隐球菌而不是其他感染更常见，可能会揭示出更多有关肉芽肿形成机制和结节病本身性质的信息。

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