1、, ,CASE REPORT,CN（cryptococcus neoformans）,as a cause of,BOOP (bronchiolitis obliterans organizing pneumonia),CN（cryptococcus neoformans）,1、immunocompromised patients：,2、immunocompetent individuals：,systemic infections,localized pulmonary disease,BOOP (bronchiolitis obliterans organizing pneumonia )
2、,a rare severe form of pneumonitis caused by a variety of infectious and toxic agents or connective tissue diseases,1、BOOP due to CN has very rarely been reported; 2、mostly in immunocompromised patients.,We report a case： CN-associated BOOP in an immunocompetent individual and discuss the diagnosis
3、and treatment of this entity.,*a 30-year old healthy Caucasian male,*10-day history of fever/chills and nonproductive cough,*denied any tobacco or illicit substance use,*a recent hunting trip to Canada,oxygen saturation level was normal,a chest radiograph showed right upper lobe consolidation.,oral
4、levofloxacin,returned 3 days later with persistent fever, cough, and headache.,hospitalized,intravenous ceftriaxone and azithromycin,A repeated chest radiograph/CT-scan:,bilateral upper and lower lobe consolidations and nodularity,image,image,oral steroids fluconazole ,400mg/d, 3-month course,remain
5、ed asymptomatic had no pulmonary infiltrates on chest radiograph.,9 months of follow-up,Discussion,1、observation alone without specific therapy 2、 treatment of symptomatic patients, particularly those with extensive disease on chest radiographs 3、high titers of serum cryptococcal antigen are believe
6、d to be a marker of systemic cryptococcal disease 4、antifungal therapy can probably be postponed with close observation for 23 months 5、oral fluconazole is an alternative,6、BOOP：an inflammatory/fibrosing process involving the small airways that often results in progressive, irreversible obstructive
7、pulmonary disease 7、pathogenesis：damage of the bronchiolar epithelial cells and recruitment of T lymphocytes and neutrophils to the site of injury; many cytokines and chemokines are secreted, perpetuating the inflammatory response and leading to fibroblast formation with obliteration of the airways,
8、5 case reports of an association between Cryptococcus and BOOP we report on a case of an immunocompetent young adult without history of previous lung disease who presented with a prolonged course of significant lung involvement and BOOP.,CN should be kept in mind as a possible etiology in patients who present with severe pneumonitis or bronchiolitis, even if they do not have AIDS or other immunosuppression, as this case illustrates.,you can contact me ：email Tel. 15805160337Ad. seu.university,nanjing,jiangsu,China,
