Tuberc Respir Dis.  2012 Sep;73(3):182-186. 10.4046/trd.2012.73.3.182.

Pulmonary Cryptococcosis Mimicking Primary Lung Cancer with Multiple Lung Metastases

  • 1Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 2Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea.


Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.


Cryptococcosis; Lung Neoplasms; Multiple Pulmonary Nodules

MeSH Terms

Diagnosis, Differential
Follow-Up Studies
Immunocompromised Host
Lung Neoplasms
Multiple Pulmonary Nodules
Neoplasm Metastasis


  • Figure 1 Simple chest radiograph shows a large irregular mass-like lesion in the left upper lobe with multiple opacities in both lungs.

  • Figure 2 Chest computed tomography reveals a large consolidative mass in the left upper lobe (about 10 cm in longest diameter) and multiple nodular consolidations with small nodules in both lungs.

  • Figure 3 Histologic findings of percutaneous computed tomography-guided biopsy from mass in the left upper lobe. (A) Many yeast-form fungal organisms (arrow) are observed on the hematoxylin and eosin stain (×200). (B) Multiple fungal colonies with some budding yeasts, strongly stained by Gomori's methenamine-silver stain (×200).

  • Figure 4 After treatment with oral fluconazole for 4 months, chest radiographs shows significant decrease in size of the consolidative pulmonary mass in the left upper lobe and multiple nodular consolidations with small nodules in both lungs.


1. Brizendine KD, Baddley JW, Pappas PG. Pulmonary cryptococcosis. Semin Respir Crit Care Med. 2011. 32:727–734.
2. Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009. 23:525–530.
3. Hung MS, Tsai YH, Lee CH, Yang CT. Pulmonary cryptococcosis: clinical, radiographical and serological markers of dissemination. Respirology. 2008. 13:247–251.
4. Nadrous HF, Antonios VS, Terrell CL, Ryu JH. Pulmonary cryptococcosis in nonimmunocompromised patients. Chest. 2003. 124:2143–2147.
5. Goldman JD, Vollmer ME, Luks AM. Cryptococcosis in the immunocompetent patient. Respir Care. 2010. 55:1499–1503.
6. Mylonakis E, Muse VV, Mino-Kenudson M. Case records of the Massachusetts General Hospital. Case 28-2011. A 74-year-old man with pemphigus vulgaris and lung nodules. N Engl J Med. 2011. 365:1043–1050.
7. Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 2005. 236:326–331.
8. Song KD, Lee KS, Chung MP, Kwon OJ, Kim TS, Yi CA, et al. Pulmonary cryptococcosis: imaging findings in 23 non-AIDS patients. Korean J Radiol. 2010. 11:407–416.
9. Choe YH, Moon H, Park SJ, Kim SR, Han HJ, Lee KS, et al. Pulmonary cryptococcosis in asymptomatic immunocompetent hosts. Scand J Infect Dis. 2009. 41:602–607.
10. Chang WC, Tzao C, Hsu HH, Lee SC, Huang KL, Tung HJ, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest. 2006. 129:333–340.
11. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010. 50:291–322.
12. Garrett L, Marr K, West S, Allada G. 74-year-old man from the pacific northwest with fever and a lung mass. Chest. 2011. 140:814–817.
Full Text Links
  • TRD
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: