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Pulmonary cryptococcosis mimicking solitary lung cancer in an immunocompetent patient
  1. E-T Chang1,
  2. A H Wang3,
  3. C-B Lin1,
  4. J-J Lee1,
  5. S-H Liu2
  1. 1
    Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
  2. 2
    Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
  3. 3
    Department of Bioengineering, School of Engineering and Applied Science, University of California-Los Angeles, Los Angeles, California, USA
  1. Dr C-B Lin, 707, Sec. 3 Chung-Yang Rd, Hualien, Taiwan 970, ROC; evan7622{at}yahoo.com.tw

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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.

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.
Figure 2 Microscopic examination of the lung tissue showing pulmonary cryptococcosis (arrow). HE, haematoxylin-eosin stain; GMS, Gomori methenamine silver stain.

DISCUSSION

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

Learning points

  • Pulmonary cryptococcus can present as a malignant mass with positive accumulation on the FDG-PET scan.

  • Antifungal drugs may be an appropriate treatment without surgical intervention.

REFERENCES

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Footnotes

  • Competing interests: None.

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

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