Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, Guizhou, China , 807442003@qq.com
Abstract: (667 Views)
Pulmonary cryptococcosis (PC) of the lungs is a fungal infection often occurring in immunocompromised patients, which is most commonly contracted by inhalation. Here, we report the case of a 44-year-old woman who had undergone modified radical surgery for stage I intraductal carcinoma of the left breast one year earlier and had been undergoing endocrine therapy with tamoxifen. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) findings indicated multiple pulmonary nodules, which was highly suspicious of lung metastasis from breast cancer. However, the pathological results suggested cryptococcus infection. The patient was subsequently treated with itraconazole antifungal therapy. However, a chest computed tomography (CT) examination one month later revealed that both lung lesions were still present. Her clinician suspected they were due to her intake of the estrogen receptor inhibitor tamoxifen and asked her to stop temporarily taking the drug. One month later, chest CT reexamination revealed that the lung lesions had disappeared. So far, there have been no reports of pulmonary cryptococcosis caused by tamoxifen after breast cancer surgery. Our case study suggests that PC infection may be one of the rare side effects of tamoxifen and should be considered in the differential diagnosis of multiple nodules in both lungs in patients with a history of cancer surgery and taking estrogen receptor inhibitors. Therefore, the etiology of infections should be considered in the differential diagnosis, especially in patients taking estrogen receptor inhibitors after tumor surgery.
1. 1. Setianingrum F, Rautemaa-Richardson R, Denning DW (2019) Pulmonary cryptococcosis: A review of pathobiology and clinical aspects. Medical Mycology, 57(2): 133-50. [DOI:10.1093/mmy/myy086] [PMID]
2. Chang WC, Tzao C, Hsu HH, et al. (2006) Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest, 129(2): 333-40. [DOI:10.1378/chest.129.2.333] [PMID]
3. Núñez M, Peacock JE, Jr., Chin R, Jr (2000) Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. Chest, 118(2): 527-34. [DOI:10.1378/chest.118.2.527] [PMID]
4. Li L, Zhuang L, Zhou J, Shao C (2018) Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature. Journal of Medical Case Reports, 12(1): 327. [DOI:10.1186/s13256-018-1853-2] [PMID] []
5. Della Torre S and Maggi A (2017) Sex differences: A Resultant of an Evolutionary Pressure? Cell Metabolism, 25(3): 499-505. [DOI:10.1016/j.cmet.2017.01.006] [PMID]
6. Mohr JA, Long H, McKown BA, Muchmore HG (1972) In-vitro susceptibility of Cryptococcus neoformans to steroids. Sabouraudia, 10(2): 171-2. [DOI:10.1080/00362177285190331]
7. Brizendine KD, Baddley JW, Pappas PG (2013) Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PloS one, 8(3): e60431. [DOI:10.1371/journal.pone.0060431] [PMID] []
8. Honma N, Horii R, Iwase T, et al. (2008) Clinical importance of estrogen receptor-beta evaluation in breast cancer patients treated with adjuvant tamoxifen therapy. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 26(22): 3727-34. [DOI:10.1200/JCO.2007.14.2968] [PMID]
9. Toyoda Y, Miyashita T, Endo S, et al. (2011) Estradiol and progesterone modulate halothane-induced liver injury in mice. Toxicology Letters, 204(1): 17-24. [DOI:10.1016/j.toxlet.2011.03.031] [PMID]
10. Murphy AJ, Guyre PM, Pioli PA (2010) Estradiol suppresses NF-kappa B activation through coordinated regulation of let-7a and miR-125b in primary human macrophages. Journal of Immunology (Baltimore, Md : 1950), 184(9): 5029-37. [DOI:10.4049/jimmunol.0903463] [PMID] []
11. Trenti A, Tedesco S, Boscaro C, et al. (2018) Estrogen, Angiogenesis, Immunity and Cell Metabolism: Solving the Puzzle. International Journal of Molecular Sciences, 19(3). [DOI:10.3390/ijms19030859] [PMID] []
12. Guimarães MD, Marchiori E, Meirelles GS, et al. (2013) Fungal infection mimicking pulmonary malignancy: clinical and radiological characteristics. Lung, 191(6): 655-62. [DOI:10.1007/s00408-013-9506-0] [PMID]
13. Kuhlman JE, Fishman EK, Siegelman SS (1985) Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology, 157(3): 611-4. [DOI:10.1148/radiology.157.3.3864189] [PMID]
14. Ghimire P and Sah AK (2011) Pulmonary cryptococcosis and tuberculoma mimicking primary and metastatic lung cancer in 18F-FDG PET/CT. Nepal Medical College Journal : NMCJ, 13(2): 142-3.
15. Guarner J and Brandt ME (2011) Histopathologic diagnosis of fungal infections in the 21st century. Clinical Microbiology Reviews, 24(2): 247-80. [DOI:10.1128/CMR.00053-10] [PMID] []
16. Zhao L, Tong L, Lin J, et al. (2015) Characterization of solitary pulmonary nodules with 18F-FDG PET/CT relative activity distribution analysis. European Radiology, 25(7): 1837-44. [DOI:10.1007/s00330-015-3592-8] [PMID]
17. Wang SY, Chen G, Luo DL, et al. (2017) (18)F-FDG PET/CT and contrast-enhanced CT findings of pulmonary cryptococcosis. European Journal of Radiology, 89: 140-8. [DOI:10.1016/j.ejrad.2017.02.008] [PMID]
18. Hsu CH, Lee CM, Wang FC, Lin YH (2003) F-18 fluorodeoxyglucose positron emission tomography in pulmonary cryptococcoma. Clinical Nuclear Medicine, 28(9):791-3. [DOI:10.1097/01.rlu.0000082680.98898.2b] [PMID]
19. Chang CC, Sorrell TC, Chen SC (2015) Pulmonary Cryptococcosis. Seminars in Respiratory and Critical Care Medicine, 36(5): 681-91. [DOI:10.1055/s-0035-1562895] [PMID]
Hu H, Hu X, Li D, Cai J. Cryptococcosis mimicking pulmonary metastasis during treatment with tamoxifen for breast cancer after surgery: A case report. Int J Radiat Res 2023; 21 (4) :845-848 URL: http://ijrr.com/article-1-5095-en.html