SURGICAL MANAGEMENT OF REFRACTORY PULMONARY CRYPTOCOCIS adrianafloresjuarez@gmail.com

 

SURGICAL MANAGEMENT OF REFRACTORY PULMONARY CRYPTOCOCIS

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Mexico

Oral or Poster

Pulmonary cryptococcosis affects immunocompromised patients. Refractoriness occurs in 10–15% of patients, with a high fungal load (a titer greater than 1:1024), excessive production of polysaccharide capsules, or the presence of biofilms that decrease drug penetration. Surgical intervention for cavitary masses, solitary nodular lesions, or when malignancy is suspected.Isolated accounts for 10–30% of cases, is most common in young adult men. C. neoformans is the most frequently species. Only 2% of HIV-infected individuals have respiratory symptoms due to cryptococcosis. Pulmonary nodules are the most common visual indicator of cryptococcosis. Amphotericin B, fluconazole, and 5-flucytosine are the most commonly used drugs in cryptococcosis therapy.

A 23-year-old male with advanced HIV. Chest CT revealed subpleural nodular with central areas of lower attenuation in the upper segment of the left lower lobe, accompanied by peripheral satellite nodules and a "budding tree" pattern. Bronchoalveolar lavage was performed and India ink staining was positive. Therapy for Cryptococcus was initiated. Percutaneous biopsy, PAS staining, and Grocott staining positive for pulmonary cryptococcosis on the HPT. The persistence of the lung lesion, wedge resection of the subpleural nodule was performed to control the focus of pulmonary cryptococcosis.

surgical approach allows the histopathological diagnosis, rule out malignant lesions and achieve resolution of the lesion when persists despite antifungal treatment

Prolonged use of antiretrovirals and advanced immunodeficiency (CD4 <100 cells/µL) favors an attenuated inflammatory response or tissue persistence of fungal infections. Immune reconstitution after antiretroviral therapy generates immune reconstitution inflammatory syndrome, contributing to the persistence of the lesion.