Pulmonary cryptococcosis

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

Presented to the emergency room with complaints of pain in the right side of the thorax, and radiation to the ipsilateral arm, starting 8 hours ago. She had no fever or other abnormalities, nor did she have a history of immunosuppression.

Patient Data

Age: 55 years
Gender: Female
CT

Right upper lobe subpleural mass, which measures 3,2 cm, and airspace consolidation at the lateral segment of the middle lobe, associated with several scattered nodules distributed in both lungs, predominantly in the right lung. 

There are hilar and mediastinal lymphadenopathy, as well as enlarged lymph nodes in the axillary regions and pectoral chains. 

No pericardial or pleural effusion.

The patient underwent a pulmonary biopsy of the right upper lobe mass guided by CT.

Pathology

Microscopy

Histology reveals Granulomatous lesion characterized by the presence of fibrosis and infiltration with lymphocytes and plasma cells that contained encapsulated yeastlike organisms, typical of Cryptococcosis neoformans. Fungi are stained and visible, separated by one another by thick mucoid polysaccharide capsule.

Conclusion: Cryptococcus neoformans, with negative results for acid-fast bacilli and malignancy.

Case Discussion

Pulmonary cryptococcosis is an infection of the lungs caused by cryptococcus neoformans 1-3. The radiologic findings of cryptococcal infection vary according to immune status 3-7. The most common CT manifestations in immunocompetent individuals are multiple scattered or clustered nodules, solitary pulmonary nodule, as well as mass-like and consolidation 3-7. Lymphadenopathy and pleural effusion may infrequently occur 3-7.

The current case illustrates a presentation of an immunocompetent patient with histopathological proven pulmonary cryptococcosis and demonstrates the diagnostic challenge this infection poses to the radiologist.

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Case information

rID: 78154
Published: 2nd Jun 2020
Last edited: 12th Jun 2020
System: Chest
Inclusion in quiz mode: Included
Institution: Real Hospital Português de Pernambuco - Recife, PE - Brazil