Missed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review

错过了在 COVID-19 患者中识别隐球菌病的机会:病例报告和文献综述

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作者:Daniel B Chastain, Andrés F Henao-Martínez, Austin C Dykes, Gregory M Steele, Laura Leigh Stoudenmire, Geren M Thomas, Vanessa Kung, Carlos Franco-Paredes

Abstract

SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.

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