Primary abdominal lymphonodular cryptococcosis in children: 2 case reports and a literature review

Abstract Background Cryptococcus neoformans is an important opportunistic fungal pathogen that is acquired via the respiratory tract. It causes several clinical syndromes and most commonly presents as meningitis. The establishment of C neoformans infections in immunocompetent individuals could be owing to increased virulence, dose of the organism, or genetically determined differences in the ability to generate a protective immune response against the organism. Objectives The purpose of this study is to report on 2 case studies and a literature review and to discuss the diagnosis and management of primary abdominal lymphonodular cryptococcosis. Methods We conducted 2 case studies and a literature review. Results Two cases of primary abdominal lymphonodular cryptococcosis in childhood were reported herein. The patients suffered from C neoformans without immunoglobulin or lymphocyte abnormalities. The cause of hospitalization of the 2 cases was mainly the persisting fever with or without abdominal pain. Imaging findings indicated dramatic lymphadenopathy and light hepatosplenomegaly. Excision biopsy of the abnormal lymph node demonstrated reactive lymphoid hyperplasia and the presence of C neoformans . The results of nested polymerase chain reaction confirmed the diagnosis of C neoformans . Conclusion This is the first report on C neoformans in the primary abdominal lymph node in children. This report suggests that C neoformans infection should be considered in the differential diagnosis of fever and marked lymphadenopathy, and empirical administration of antifungal agent may be necessary. C neoformans antibody test, polymerase chain reaction assay, fine-needle aspiration biopsy, or surgical excision biopsy is needed in early diagnosis.