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KMID : 0616619970030030181
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Journal of Soonchunhyang Medical College
1997 Volume.3 No. 3 p.181 ~ p.190
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Two Cases of Cryptococcosis
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尹泰權/Yoon, T.K.
崔衡鎭/李東煥/李尙柱/Choi, H.J./Lee, D.H./Lee, S.J.
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Abstract
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We experienced two cases of cryptococcosis which were diagnosed by India-ink stain and culture of cerebrospinal fluid and biopsy with culture of skin lesion or´lymph nodes. Both cases were confused with tuberculous meningitis or miliary tuberculosis because of irregular densities in hilum and tattered miliary sized nodules in chest X-ray, family history of pulmonary tuberculosis avid clinical symptoms. Two patients were boys who were 3 and 2 year-old, lived in Daejon city and were admitted in April, 1978 and 1980.-
Anti-tuberculosis medications were applied at first without improvement in both cases of which Mantoux tests were negative. After confirmation of diagnosis, amphotericin-B was administered intravenously, intrathecally and topically with 5-fluorocytosine orally, which brought improvement in case ff and death in case I, so differential diagnosis with cryptococcosis should be necessary in the case of suspicious tuberculosis (tuberculous meningitis or miliary tuberculosis) with negative Mantoux test.
In fatal case I, meningeal irritation signs with increased intracranial pressure and more than 300/mm3 of leukocytes, decreased level of sugar below 30mg / , decreased level of chloride and increased level of protein more than 100mg/ in cerebrospinal fluid were found and it was thought to be infiltrated in central nervous system, lungs and liver.
No meningeal irritation signs without increased intracranial pressure and below 100/mm3 of leukocytes, more than 30 mg9b of sugar and normal level of chloride and protein in cerebrospinal fluid could be found in improved case 1, which was thought to be infiltrated in central nervous system, lungs, liver, spleen, lymph nodes and skin. We made a brief review of literature.
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