IMAGES IN THORAX

Pulmonary cryptococcosis mimicking solitary lung cancer in an immunocompetent patient

E-T Chang¹, A H Wang³, C-B Lin¹, J-J Lee¹, S-H Liu²

¹ Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
² Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
³ Department of Bioengineering, School of Engineering and Applied Science, University of California-Los Angeles, Los Angeles, California, USA

Correspondence to:
Dr C-B Lin, 707, Sec. 3 Chung-Yang Rd, Hualien, Taiwan 970, ROC; evan7622{at}yahoo.com.tw

A 48-year-old Chinese male henhouse keeper was admitted with dyspnoea. A plain chest radiograph and CT scan indicated a solitary right lung mass with invasion to the trachea (fig 1A and B). Positron emission tomography with ¹⁸F-fluoro-2-deoxy-D-glucose (FDG-PET) showed accumulation in the lung mass (fig 1C). A transbronchial biopsy specimen provided a pathological diagnosis of pulmonary cryptococcosis (fig 2). There were no malignant cells in the specimen. A fungus culture grew Cryptococcus neoformans, but a study of the cerebrospinal fluid showed no evidence of cryptococcal meningitis. A serum HIV test was negative. The patient was treated with oral itraconazole 400 mg/day for 1 year without surgical intervention. A CT scan of the thorax after 2 years showed no evidence of the pulmonary lesion.

View larger version (105K): in this window | in a new window | PowerPoint for Teaching   Figure 1 (A) Chest radiograph and (B) CT scan showing a solitary mass over the right upper lung area. (C) FDG-PET scan showing positive accumulation in the solitary mass.

 

View larger version (115K): in this window | in a new window | PowerPoint for Teaching   Figure 2 Microscopic examination of the lung tissue showing pulmonary cryptococcosis (arrow). HE, haematoxylin-eosin stain; GMS, Gomori methenamine silver stain.

 

DISCUSSION

TOP DISCUSSION REFERENCES

The high-resolution CT characteristics of pulmonary cryptococcosis in immunocompetent patients are multiple nodules and solitary nodules.¹ FDG-PET is a relatively new imaging modality that facilitates the distinction between benign and malignant lesions, but some reports show accumulation on chronic inflammation.²

FOOTNOTES

Competing interests: None.

Patient consent: Patient consent was obtained to submit this case report.

REFERENCES

TOP DISCUSSION REFERENCES

1. Murayama S, Sakai S, Soeda H, et al. Pulmonary cryptococcosis in immunocompetent patients: HRCT characteristics. J Clin Imaging 2004; 28: 191–5.[CrossRef]
2. Hsu CH, Lee CM, Wang FC, et al. F-18 fluorodeoxyglucose positron emission tomography in pulmonary cryptococcoma. Clin Nucl Med 2003; 28: 791–3.[CrossRef][Medline]

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