Presentation
Chronic cough despite multiple courses of antibiotics.
Patient Data
Nodular densities project over the left mid to lower zones. Right lung is clear. Cardiomediastinal contour is normal.
Multiple nodular opacities throughout the left lung with the largest in the lingular segment measuring 44 mm. The opacities are peripheral in nature. No cavitation. No lymphadenopathy.
Background emphysematous changes. No pleural or pericardial effusion. No enlarged lymph nodes.
Case Discussion
The patient underwent bronchoscopy and biopsy of the largest lingular lesion.
Histopathology
MICROSCOPIC APPEARANCE: Sections show fragments of bronchial wall including mucosa, smooth muscle, submucosal glands and cartilage together with adjacent lung parenchyma. In one of the lung fragments, there is an area of necrosis with palisaded fibroblasts and histiocytes at the periphery. In the necrotic material are scattered encapsulated PAS+ yeasts about 5 microns in diameter. The lung parenchyma elsewhere retains normal architecture. Pigment bearing macrophages are present in some air spaces and there is an interstitial infiltrate of lymphocytes, histiocytes and plasma cells.
DIAGNOSIS: Biopsy of lingular of lung: Cryptococcosis.
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