Cryptococcal infection is commonly seen in immunocompromised patients, although immunocompetent patients may also be infected. The pathogen’s portal of entry is the respiratory tract; however, the central nervous system is predominantly involved. Pulmonary involvement varies from interstitial and alveolar infiltrations to large masses, which are frequently first interpreted as lung neoplasm. The diagnosis of pulmonary cryptococcosis, in these cases, is frequently challenging, which, in most cases, requires histopathological examination.
The authors report the case of a young female patient who presented a 20-day history of chest pleuritic pain and fever at the onset of symptoms. HIV serology was negative and CD4 count was normal. The imaging work-up was characterized by a huge opacity in the left inferior pulmonary lobe with a wide pleural base. Computed tomography showed a heterogeneous mass involving the bronchial tree. Mediastinal involvement was poor, and there was a splenomegaly. The patient underwent an exploratory thoracotomy and inferior lobectomy. The histopathological examination revealed a cryptococcoma. As the serum antigenemia was positive, the patient was scheduled for long-term treatment with fluconazole. The authors call attention to including the cryptococcal infection in the differential diagnosis of lung mass, mainly when localized in the lung bases in immunocompetent patients.
SinghR, JoshiD, GuptaA, GanganeN. Large pulmonary cryptococcoma and cryptococcal meningitis in an immunocompetent patient: a case report. Diagn Cytopathol. 2010;38(12):929-31. 10.1002/dc.21345.20301210
PisarevskyAA, LarrieraA, CeanP, PetrucciEA. Pulmonary cryptococcoma with involvement of the chest wall in an immunocompetent patient. Medicina (B Aires). 2010;70(2):166-8.
GoldmanJD, VollmerME, LuksAM. Cryptococcosis in the immunocompetent patient. Respir Care. 2010;55(11):1499-503.20979679
CouraJR. Dinâmica das doenças infecciosas e parasitárias. 2nd ed. São José: Guanabara Koogan; 2013. p.1250-60.
HoCL, ChangBC, HsuGC, WuCP. Pulmonary cryptococcoma with CD4 lymphocytopenia and meningitis in an HIV-negative patient. Respir Med. 1998;92(1):120-2. 10.1016/S0954-6111(98)90043-9.9519236
KebedeT, RedaN. Pulmonary cryptococcoma mimicking pulmonary malignancy in an immunocompetent adult: a case report. Ethiop Med J. 2012;50(3):275-8.23409412
AhsanuddinAN, WilliamsHJ. Pathologic quiz case: solitary lung nodule in a 77-year-old male smoker. Pulmonary cryptococcoma. Arch Pathol Lab Med. 2003;127(12):1631-2.14632561
PerfectJR, DismukesWE, DromerF, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291-322. 10.1086/649858.20047480
MorettiML, ResendeMR, LazéraMS, ColomboAL, Shikanai-YasudaMA. Guidelines in cryptococcosis--2008. Rev Soc Bras Med Trop. 2008;41(5):524-44.19009203
SaagMS, GraybillRJ, LarsenRA, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis. 2000;30(4):710-8. 10.1086/313757.10770733
MitchellDH, SorrellTC. Pancoast’s syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii. Clin nfect Dis. 1992;14(5):1142-4. 10.1093/clinids/14.5.1142.