Pulmonary cryptococcosis

Case contributed by Dr Yune Kwong

Presentation

History of previous renal transplant. Now septic.

Patient Data

Age: 70-75 years old
Gender: Male
Modality: CT

Multiple nodules (some cavitating) in the left lower lobe

Modality: Nuclear medicine

Multiple nodules (some cavitating) in the left lower lobe, with PET uptake. Previous CT 2 weeks ago (not shown) was unremarkable. Given the short interval, appearances likely secondary due to infection.

Modality: CT

CT guided biopsy of left lower lobe nodule.

HISTOLOGY

MACROSCOPIC DESCRIPTION: A core of pale tan tissue measuring 8mm  in  length  and  1mm  in  diameter  and multiple fragments less than 1mm each measuring in aggregate 3 x 2 x 1mm.

MICROSCOPIC DESCRIPTION: Sections of lung biopsy shows alveolar spaces containing multiple rounded/ovoid to slightly irregular shaped yeast-like forms.  They are of variable  size  and there appears to be a capsule.  No obvious inflammatory reaction is noted.  No granulomas and no acid fast bacilli are noted.  No evidence  of  malignancy  is identified.     

DIAGNOSIS: Lung biopsy :  Fungal elements seen.  Appearance raises suggestion of Cryptoccoccus. Please correlate with microbiology.

 

Microbiology

Specimen site  Left lung biopsy

Microscopy     Fungal elements seen

Gram Stain     ++ Polymorphs, No organisms seen

Culture        + Cryptococcus neoformans

Case Discussion

Cryptococcosis has variable manifestations in the lung. This case demonstrates the scattered nodular pattern.

In a patient with previous transplant, the differential for multiple pulmonary nodules includes infection, metastases and post-transplant lymphoproliferative disorder.

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Case Information

rID: 32973
Case created: 23rd Dec 2014
Last edited: 16th Dec 2015
System: Chest
Inclusion in quiz mode: Included

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