A CASE OF DISSEMINATED CRYPTOCOCCOSIS PRESENTING WITH JEJUNAL PERFORATION

This paper describes a case of disseminated cryptococcosis presenting with jejunal perforation. A 46-year-old man, who had an episode of liver cirrhosis and orally took 30mg/day of prednisolone for nephrotic syndrome, was admitted to the hospital because of postprandial severe upper abdominal pain. He was diagnosed as having an intestinal perforation and an emergency operation was carried out. A whole-circumference ulcer with irregular margin was found at the jujunum about 90cm from the ligament of Treitz. The lesion was resected, nevertheless he died of multiple organ failure on the 35th postoperative day. Histological examination of the specimen indicated transmural epitheloid granuloma with diffuse infiltration of cryptococcus. Autopsy revealed cryptococcal infection in multiple organs. It was finally diagnosed as disseminated cryptococcosis. Judging from the shape of circular ulcer and cell-mediated immunosuppressive condition, it was suggested that infectious mechanism would depend upon lymphatic and hematogenous spreading pattern similar to tuberculosis.