Korean J Med.  2015 Jul;89(1):91-96. 10.3904/kjm.2015.89.1.91.

A Case of Disseminated Cryptococcosis Mimicking Lung Cancer and Prostate Cancer in an Immunocompetent Patient: A Review of the Literature

• Lee Y
• Kim JH
• Seo H
• Park H
• Oh YM
• Lee SD
• Lee JS

• KMID: 2269056
• DOI: http://doi.org/10.3904/kjm.2015.89.1.91

Abstract

Cryptococcosis can occur in immunocompetent patients; in fact, it accounts for 20% of all cryptococcal infections. In immunocompetent patients, although clinical symptoms may not be obvious, cryptococcosis should be considered in the differential diagnosis for cancer and other diseases. We recently encountered a case of disseminated cryptococcosis involving the lung and prostate. A 71-year-old male patient was referred for evaluation of a large pleural effusion. He was a 40 pack-years ex-smoker, and showed no evidence of immunodeficiency. Chest computed tomography and positron emission tomography images suggested primary lung cancer with pleural metastases and prostate cancer. Tuberculous pleurisy was suspected due to a lymphocyte-dominant exudative pleural effusion and high level of adenosine deaminase. Prostate and bronchoscopic biopsies demonstrated chronic granulomatous inflammation, and periodic acid Schiff's and Grocott's methenamine silver staining confirmed cryptococcosis in both specimens. Antifungal therapy with fluconazole was started, and follow-up images showed complete resolution of the pleural effusion.

Keyword

Immunocompetent; Cryptococcosis; Lung neoplasms; Prostatic neoplasms; Fluconazole

MeSH Terms

Adenosine Deaminase
Aged
Biopsy
Cryptococcosis*
Diagnosis, Differential
Fluconazole
Follow-Up Studies
Humans
Inflammation
Lung
Lung Neoplasms*
Male
Methenamine
Neoplasm Metastasis
Periodic Acid
Pleural Effusion
Positron-Emission Tomography
Prostate
Prostatic Neoplasms*
Thorax
Tuberculosis, Pleural
Adenosine Deaminase
Fluconazole
Methenamine
Periodic Acid