PMC10041989_01
Colonoscopy revealed extensive colitis, with wide mucosal defect and spontaneous bleeding in the sigmoid colon on first admission (A). No obvious abnormality was found on chest CT (B). The colonoscopy (C) and a mass shadow right lower lung lobe (D) after infliximab treatment for four times.
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Colonoscopy revealed extensive colitis, with wide mucosal defect and spontaneous bleeding in the sigmoid colon (Figure 1A). CT (Figure 1B). Cytomegalovirus (CMV) inclusion bodies showed positivity. Although the stool returned to normal with improvement of laboratory tests and lesions under colonoscopy (Figure 1C) after infliximab treatment for 4 times, the patient still had a fever (the temperature is about 38 C), with no other respiratory symptoms. A recheck of the chest CT showed a mass shadow right lower lung lobe (Figure 1D).
Hematoxylin and eosin stained (A), periodic acid-Schiff stained (B) and hexamine silver stained (C) section of core biopsy of lung lesion (200x). Multiple variable size encapsulated yeast cells are present (arrows). After vedolizumab treatment for 3 times, reexamined colonoscopy showed a slight pseudomembranous colitis in rectum sigmoid colon (D). After 3 months of treatment with voriconazole, the lung lesions were absorbed mostly (E).
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Puncture and biopsy of the lung mass guided by B-ultrasound revealed granulomatous inflammation and necrosis, with multiple variable-sized encapsulated yeast cells present in hematoxylin and eosin staining, hexamine silver staining and periodic acid-Schiff staining (Figure 2A-C), the final diagnosis is Cryptococcus neoformans pneumonia. After vedolizumab treatment for 3 times, reexamined colonoscopy showed a slight pseudomembranous colitis in rectum sigmoid colon (Figure 2D), followed by positive results of fecal Clostridium difficile toxin test. After 3 months of treatment with voriconazole, the lung lesions were mostly absorbed (Figure 2E).