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Images in Thorax
Pulmonary cryptococcosis mimicking solitary lung cancer in an immunocompetent patient
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  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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http://dx.doi.org/10.1136/thx.2007.079244

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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
    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
    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

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

    • Competing interests: None.

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

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    2008 BMJ Publishing Group and British Thoracic Society