{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T12:10:04Z","timestamp":1751458204924,"version":"3.41.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:italic>Cryptococcosis<\/jats:italic> is an opportunistic and potentially fatal fungal infectious disease. Pemphigus diseases are characterized by blistering of the cutaneous and mucous membranes. We report a case of pulmonary <jats:italic>cryptococcosis<\/jats:italic> (PC) following methylprednisolone treatment for pemphigus vulgaris. Additionally, we analyzed a case series of PC infections recorded in PUBMED from 2013 to 2023. A total of 229 cases of PC were included. The median age was 54\u202fyears, with 66.4% of patients being male. Those with previous use of corticosteroids or immunosuppressives accounted for 38.4% of cases. Underlying conditions included solid organ transplantations (25.7%), respiratory diseases (6.6%), malignant tumors (6.1%), rheumatoid arthritis (5.7%), hematological malignancies (4.4%), among others. The main source of infection was exposure to birds, poultry, and their feces (12.7%). <jats:italic>Cryptococcus neoformans<\/jats:italic> was most frequently isolated (76.4%). Overall mortality was 14.8%. Previous use of corticosteroids or immunosuppressants was a risk factor for disseminated <jats:italic>cryptococcus<\/jats:italic> (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Age, underlying disease, dissemination, and no antifungal therapy were independently associated with increased mortality (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Co-occurrence of pemphigus and PC is rare. Prompt diagnosis and appropriate treatment of PC are essential to prevent fatal consequences. Corticosteroids or immunosuppressive therapy are associated with the development of disseminated cryptococcal infection. Age, underlying disease, and dissemination are related to increased mortality. Timely antifungal therapy can improve prognosis.<\/jats:p>","DOI":"10.3389\/fmed.2025.1569949","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T11:33:11Z","timestamp":1751455991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary cryptococcosis in the setting of immunosuppression by methylprednisolone monotherapy for oral pemphigus: a case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Hongxia","family":"Mei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengchen","family":"Bao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongxu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhijing","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yakai","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinming","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"WenYang","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1038\/s41579-021-00511-0","article-title":"Treatment strategies for cryptococcal infection: challenges, advances and future outlook","volume":"19","author":"Iyer","year":"2021","journal-title":"Nat Rev Microbiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.fgb.2014.10.003","article-title":"Cryptococcosis diagnosis and treatment: what do we know now","volume":"78","author":"Perfect","year":"2015","journal-title":"Fungal Genet Biol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1128\/jcm.15.3.535-537.1982","article-title":"Improved diagnostic medium for separation of Cryptococcus neoformans var. neoformans (serotypes a and D) and Cryptococcus neoformans var. gattii (serotypes B and C)","volume":"15","author":"Kwon-Chung","year":"1982","journal-title":"J Clin Microbiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2013\/471363","article-title":"New insights into HIV\/AIDS-associated Cryptococcosis","volume":"2013","author":"Antinori","year":"2013","journal-title":"ISRN AIDS"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1399-3062.2006.00149.x","article-title":"Cryptococcosis in liver and kidney transplant recipients receiving anti-thymocyte globulin or alemtuzumab","volume":"9","author":"Silveira","year":"2007","journal-title":"Transpl Infect Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1086\/314606","article-title":"Cryptococcosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. Cryptococcal active surveillance group","volume":"179","author":"Hajjeh","year":"1999","journal-title":"J Infect Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e43582","DOI":"10.1371\/journal.pone.0043582","article-title":"Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative\/non-transplant","volume":"7","author":"Bratton","year":"2012","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/s11046-011-9471-1","article-title":"Cryptococcosis in China (1985-2010): review of cases from Chinese database","volume":"173","author":"Yuchong","year":"2012","journal-title":"Mycopathologia"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1378\/chest.115.3.734","article-title":"Pulmonary cryptococcosis in patients without HIV infection","volume":"115","author":"Aberg","year":"1999","journal-title":"Chest"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.1001\/jama.2020.23283","article-title":"Pulmonary fungal infections affect patients with COVID-19","volume":"324","author":"Kuehn","year":"2020","journal-title":"JAMA"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1146\/annurev-pathol-012615-044313","article-title":"Mechanisms of disease: pemphigus and bullous pemphigoid","volume":"11","author":"Hammers","year":"2016","journal-title":"Annu Rev Pathol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1111\/ced.14041","article-title":"Pemphigus vulgaris and pemphigus foliaceus: an overview of the clinical presentation, investigations and management","volume":"44","author":"Melchionda","year":"2019","journal-title":"Clin Exp Dermatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.tem.2017.10.010","article-title":"Therapeutic mechanisms of glucocorticoids","volume":"29","author":"Vandewalle","year":"2018","journal-title":"Trends Endocrinol Metab"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2143","DOI":"10.1016\/S0012-3692(15)31671-8","article-title":"Pulmonary cryptococcosis in nonimmunocompromised patients","volume":"124","author":"Nadrous","year":"2003","journal-title":"Chest"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1016\/S1473-3099(22)00499-6","article-title":"The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis","volume":"22","author":"Rajasingham","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"275","DOI":"10.7224\/1537-2073.2018-080","article-title":"Case report: Fingolimod and Cryptococcosis: collision of immunomodulation with infectious disease","volume":"21","author":"Samudralwar","year":"2019","journal-title":"Int J MS Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1111\/myc.12966","article-title":"Pulmonary cryptococcosis characteristics in immunocompetent patients-a 20-year clinical retrospective analysis in China","volume":"62","author":"Hou","year":"2019","journal-title":"Mycoses"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2015\/358926","article-title":"A case of disseminated Cryptococcal infection and concurrent lung tuberculosis in a patient under steroid therapy for interstitial pneumonia","volume":"2015","author":"Kuroda","year":"2015","journal-title":"Case Rep Pulmonol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.3389\/fimmu.2019.01744","article-title":"Glucocorticoids-all-Rounders tackling the versatile players of the immune system","volume":"10","author":"Strehl","year":"2019","journal-title":"Front Immunol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/S0140-6736(19)31778-7","article-title":"Pemphigus","volume":"394","author":"Schmidt","year":"2019","journal-title":"Lancet"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/S0190-9622(98)70426-8","article-title":"D-penicillamine-induced pemphigus foliaceus with autoantibodies to desmoglein-1","volume":"39","author":"Brenner","year":"1998","journal-title":"J Am Acad Dermatol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"210","DOI":"10.2340\/000155555573210211","article-title":"Pemphigus foliaceus induced by nifedipine","volume":"73","author":"Kim","year":"1993","journal-title":"Acta Derm Venereol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1046\/j.1365-4362.1999.00601.x","article-title":"Pemphigus and pemphigoid-like effects of nifedipine on in vitro cultured normal human skin explants","volume":"38","author":"Brenner","year":"1999","journal-title":"Int J Dermatol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"9387","DOI":"10.1038\/s41598-020-66094-7","article-title":"Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China","volume":"10","author":"Qu","year":"2020","journal-title":"Sci Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3390\/jof4020049","article-title":"An overview of sex Bias in C. neoformans infections","volume":"4","author":"Guess","year":"2018","journal-title":"J Fungi (Basel)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"ofaa004","DOI":"10.1093\/ofid\/ofaa004","article-title":"Postoperative antifungal treatment of pulmonary Cryptococcosis in non-HIV-infected and non-transplant-recipient patients: a report of 110 cases and literature review","author":"Wei","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"255","DOI":"10.2478\/jtim-2023-0111","article-title":"Mini-dose methotrexate combined with methylprednisolone as a first-line treatment for acute graft-versus-host disease: a phase 2 trial","volume":"11","author":"Xu","year":"2023","journal-title":"J Transl Int Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"Rajasingham","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e19688","DOI":"10.1371\/journal.pone.0019688","article-title":"Evidence that the human pathogenic fungus Cryptococcus neoformans var. grubii may have evolved in Africa","volume":"6","author":"Litvintseva","year":"2011","journal-title":"PLoS One"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3390\/jof7010029","article-title":"Cryptococcus in wildlife and free-living mammals","volume":"7","author":"Danesi","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.idc.2015.10.006","article-title":"Cryptococcosis","volume":"30","author":"Maziarz","year":"2016","journal-title":"Infect Dis Clin N Am"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1128\/jcm.25.2.430-431.1987","article-title":"Cryptococcus neoformans var. gattii in Australia","volume":"25","author":"Ellis","year":"1987","journal-title":"J Clin Microbiol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e10978","DOI":"10.1371\/journal.pone.0010978","article-title":"Extracellular fibrils of pathogenic yeast Cryptococcus gattii are important for ecological niche, murine virulence, and human neutrophil interactions","volume":"5","author":"Springer","year":"2010","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e00279-21","DOI":"10.1128\/mBio.00279-21","article-title":"Cryptococcus neoformansinfected macrophages release Proinflammatory extracellular vesicles: insight into their components by multi-omics","volume":"12","author":"Zhang","year":"2021","journal-title":"MBio"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1007\/s11046-021-00575-9","article-title":"Update on pulmonary Cryptococcosis","volume":"186","author":"Yamamura","year":"2021","journal-title":"Mycopathologia"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jmii.2018.01.002","article-title":"Clinical characteristics and treatment outcomes of pulmonary invasive fungal infection among adult patients with hematological malignancy in a medical Centre in Taiwan, 2008-2013","volume":"53","author":"Chen","year":"2020","journal-title":"J Microbiol Immunol Infect"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3390\/jof4010025","article-title":"Mechanisms of pulmonary escape and dissemination by Cryptococcus neoformans","volume":"4","author":"Denham","year":"2018","journal-title":"J Fungi (Basel)"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1378\/chest.129.2.333","article-title":"Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients","volume":"129","author":"Chang","year":"2006","journal-title":"Chest"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S1473-3099(19)30278-6","article-title":"Pulmonary cryptococcosis mimicking lung cancer","volume":"19","author":"Taniwaki","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"995","DOI":"10.2169\/internalmedicine.55.5768","article-title":"Disseminated Cryptococcal infection resulting in acute respiratory distress syndrome (ARDS) as the initial clinical presentation of AIDS","volume":"55","author":"Orsini","year":"2016","journal-title":"Intern Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12941-022-00545-z","article-title":"Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report","volume":"21","author":"Qin","year":"2022","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1056\/NEJMicm2109090","article-title":"Disseminated Cryptococcosis","volume":"385","author":"Akintilo","year":"2021","journal-title":"N Engl J Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"ofw167","DOI":"10.1093\/ofid\/ofw167","article-title":"Pulmonary Cryptococcosis in the immunocompetent patient-many questions, some answers. Open forum","volume":"3","author":"Fisher","year":"2016","journal-title":"Infect Dis"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1038\/nrmicro.2015.6","article-title":"Cryptococcus: from environmental saprophyte to global pathogen","volume":"14","author":"May","year":"2016","journal-title":"Nat Rev Microbiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e60431","DOI":"10.1371\/journal.pone.0060431","article-title":"Predictors of mortality and differences in clinical features among patients with cryptococcosis according to immune status","volume":"8","author":"Brizendine","year":"2013","journal-title":"PLoS One"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"290","DOI":"10.2478\/jtim-2022-0059","article-title":"Antibiotic stewardship: dead bugs do not mutate","volume":"10","author":"Martin-Loeches","year":"2022","journal-title":"J Transl Int Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1569949\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T11:33:13Z","timestamp":1751455993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1569949\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,2]]},"references-count":46,"alternative-id":["10.3389\/fmed.2025.1569949"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1569949","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,2]]}}}