%0 Journal Article
%T Pediatric Cryptococcal Lymphadenitis in the Absence of AIDS: Case Report and Literature Review
%A Fengchang Bao
%A Hongna Tan
%A Wei Liu
%A Yange Li
%A Huixia Li
%J Case Reports in Pediatrics
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/563081
%X We present a rare case of cryptococcal lymphadenitis without immunocompromization in a two-and-a-half-year-old child. He was referred to our center with a fifteen-day history of continued fever. Ultrasound and computed tomography (CT) revealed the enlargement of multiple lymph nodes and lung reticulonodular shadows. Hematological, immunological, and microbiological tests for hepatitis, lymphoma, AIDS, and immunoglobulin deficiencies were negative. Laboratory tests demonstrated elevated erythrocyte sedimentation rate, elevated plasma and urinary £¿2-microglobulin (£¿2-MG) levels, and elevated C-reactive protein and fibrinogen. Both blood routine and bone marrow aspiration showed elevated eosinophil granulocytes. The diagnosis of cryptococcal lymphadenitis was obtained by excisional biopsy of the cervical lymph nodes. The patient was treated with intravenous amphotericin B and oral flucytosine for five weeks, then with subsequent oral fluconazole for three months. The patient is now doing well. Our case suggests that the diagnosis of cryptococcal lymphadenitis is very difficult without etiology and pathology, especially for a patient with a normal immune system; lymph node biopsy is necessary to diagnose it, and immediate antifungal treatment is necessary to treat it. 1. Introduction Cryptococcal lymphadenitis occurs commonly as an opportunistic infection in AIDS patients and may be life threatening [1¨C8]. Kim et al. reported one case of this infection in a patient with systemic lupus erythematosus [9]. This infection has several clinical but nonspecific manifestations, including pneumonia, meningitis, peritonitis, and disseminated infection. Cryptococcal lymphadenitis in the absence of AIDS is extremely rare, and it is difficult to distinguish from other lymphadenopathies such as lymphoma and tuberculosis. In the present case, we describe a pediatric case of cryptococcal lymphadenitis in a patient who did not have AIDS and who presented with multiple cervical and retroperitoneal lymph node enlargements and pulmonary inflammatory lesions. This case was misdiagnosed as lymphoma, and the final diagnosis was confirmed by cervical lymph node excisional biopsy. 2. Case Presentation A two-and-a-half-year-old child was referred to our center with a fifteen-day history of fever without an obvious remote cause. The child presented with a continued fever, with a maximum temperature of 40 degrees and without shivering, nausea, emesia, and hyperspasmia. The child was treated with two weeks of standard antibiotic treatment for pneumonia (indicated by a chest X-ray) in
%U http://www.hindawi.com/journals/cripe/2013/563081/