Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn's disease: Three case reports

BACKGROUNDCorticosteroids and anti-tumor necrosis factor alpha mAbs are widely used to treat Crohn's disease (CD). However, one disadvantage of this treatment is impairment of normal immune function, leading to an increased risk of infection. Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.CASE SUMMARYHere, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment. The patients presented with no or mild respiratory symptoms. Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes. Diagnoses were made using pathological examination and metagenomic sequencing. The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo, and symptoms were resolved. Literature searches were conducted in PubMed, Web of Science, and Embase to retrieve previously reported cases and summarize patient characteristics.CONCLUSIONThe incidence of cryptococcus infection has increased along with immunomodulator use. Clinical vigilance is required for early identification and standardized treatment.

Automated summary

This study reports three cases of pulmonary cryptococcosis in patients with Crohn's disease following immunomodulatory treatment. The patients presented with pulmonary nodules in unilateral or bilateral lobes on chest CT scans. Diagnoses were confirmed through pathological examination and metagenomic sequencing. Treatment with fluconazole 400 mg once daily resulted in symptom resolution. Literature searches were conducted to summarize patient characteristics.