Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

Background: Cryptococcal infection is a life-threatening complication in patients with connective tissue disease (CTD). This retrospective study was performed to explore the clinical features and associated factors of cryptococcosis in patients with CTD from southern China. Methods: Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. Results: A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCA-associated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%) and disseminated cryptococcosis (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meninges (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.08-1.87, P = 0.01] was associated with cryptococcosis in patients with CTD. Conclusions: Cryptococcosis developed in various organs. Typical radiological manifestation accompanied with positive serum CrAg were helpful clues for diagnosis. Lumbar puncture was a critical diagnostic method to distinguish CM. The accumulated dose of GC was associated with cryptococcosis in patients with CTD.