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KMID : 0365819650050020087
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Journal of Pusan Medical College
1965 Volume.5 No. 2 p.87 ~ p.93
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An Autopsy Case of Generalized Visceral Cryptoeoccosis without Involvement of the Central Nervous System
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Abstract
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An autopsy case of generalized visceral cryptococeosis in a 15 year old Korean boy is reported.
The patient had general edema with ascites, cough, marked jaundice associated with hepatic insufficiency, and positive Widal test. Clinically, this case was diagnosed as typhoid fever and treated as such with various kinds of antibiotics.
At autopsy the jaundice was still present, but the edema and ascites were not recognized. The body showed advanced emaciation. Grossly, there were noted numerous patchy areas scattered throughout both lungs. The liver was greatly enlarged with a mottled surface. Sectioning this structure, one could see many small foci colored yellow-green or yellow-gray in a dark redish background. The spleen was congested, but not enlarged. The swollen mesenteric lymph nodes showed areas with gelatinous appearance. The other organs and tissues were not remarkable on gross examination. Microscopically, large numbers of round or ovoid yeast-like fungi were found in the sections from the lung, liver, spleen, adrenals, and lymph nodes of the lung hilus and mesentery, which were stained with H-E, mucicarmin, P. A. S, method and technics of Gridley and methanamin-silver. The sections, however, from the organs and tissues other than those mentioned above failed to show the organisms. They were spherical, double contoured bodies with thick walls and wide transparent mucinous capsules which varied from 2 to 20 microns in diameter, not infrequently demonstrating budding forms. They occupied both intracellular and extracellular positions and were present separately or in groups in the tissues and in the spaces such as the lung alveoli, small blood vessels, capillaries, sinusoids and lymphatics. The areas where the organisms were present in groups were characterized by accumulation of transparent gelatinous or mucoid substance and, generally speaking, by little inflammatory and regressive changes. There were masses of the organisms without cellular reaction and were those with cellular reaction composed of macrophages, small round cells and a few neutrophils. The characteristic granulomatous reaction by formation of epitheloid cells and giant cells which usually takes place in fungus infection could not be identified in the involved organs and tissues.
From the morphological characteristics of the yeast-like fungi and the cellular reaction of the body to them, it seems to be most reasonable to consider this case as cryptococcosis, although mycological study on culture was not performed.
The liver is worthy of special mention. This organ showed not only the gelatinous foci sporadic in distribution, but also marked fatty metamorphosis followed by a considerable portal fibrosis extending between the lobules. The portal areas were infiltrated by large numbers of macrophages and small round cells. The bile ducts there were tending to proliferate. There was evidence of marked bile stasis. The diffuse fatty degeneration and portal scarring of the liver which would explain the hepatic insufficiency ,seemed to be well consistent with fatty nutritional cirrhosis.
On gross and microscopical examinations of this case, the most careful attention was paid to the brain and its membranes, but there was found no lesion suggestive of fungus infection. This is believed to be a case of generalized visceral cryptococcosis without involvement of central nervous
system which is associated with hepatic insufficiency resulting from diffuse fatty cirrhosis of liver.
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