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

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. chihongk@catholic.ac.kr
  • 2Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

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.

Keyword

Cryptococcosis; Lung Neoplasms; Multiple Pulmonary Nodules

MeSH Terms

Aged
Biopsy
Cryptococcosis
Diagnosis, Differential
Female
Fluconazole
Follow-Up Studies
Humans
Immunocompromised Host
Lung
Lung Neoplasms
Multiple Pulmonary Nodules
Neoplasm Metastasis
Thorax
Fluconazole

Figure

  • 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.


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