Tuberc Respir Dis.  2015 Jul;78(3):276-280. 10.4046/trd.2015.78.3.276.

A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy

• Sung JH
• Kim DH
• Oh MJ
• Lee KJ
• Bae YA
• Kwon KW
• Lee SM
• Kang HJ
• Choi J

• KMID: 2320656
• DOI: http://doi.org/10.4046/trd.2015.78.3.276

Abstract

Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

Keyword

Cryptococcosis; Pneumonia; Lymph Nodes; Biopsy, Fine-Needle

MeSH Terms

Acquired Immunodeficiency Syndrome
Adult
Biopsy*
Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Bronchoalveolar Lavage Fluid
Catheters
Cryptococcosis*
Diabetes Mellitus
Dialysis
Drug Therapy
Fluconazole
Humans
Immunocompromised Host
Korea
Lung
Lymph Nodes*
Male
Organ Transplantation
Pneumonia
Transplants
Fluconazole

Figure

• 

  Figure 1 Initial lung images. (A) Initial chest radiograph showing diffuse reticulonodular opacities in both lungs. (B) Initial chest computed tomography (CT) scan shows innumerable small nodules, interstitial thickening, and ground glass attenuation in both lungs. Note small bilateral pleural effusions. Both hilar regions are enlarged, representing lymphadenopathy. (C) Chest CT mediastinal window setting coronal image showing enlarged lymph nodes in both supraclavicular areas, both mediastinal, interlobar, and subcarinal areas.

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  Figure 2 Supraclavicular lymph node biopsy. (A) Granulomatous inflammation in cryptococcosis showing numerous multinucleated giant cells (H&E stain). (B) The periodic acid-Schiff stain reveals yeast forms of Cryptococcus separated from the cell cytoplasm by a clear space. (C) The capsule of Cryptococcus stained bright-red with mucicarmine stain (A, ×100; B and C, ×400).

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  Figure 3 Three-month follow-up lung images. (A) Chest computed tomography (CT) scan showing markedly improved small nodules in both lungs after treatment with fluconazole for 3 months. (B) Chest CT scan showing improved lymphadenopathy noted on initial chest CT scan.

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  Figure 4 Lung images at 9-month follow-up. (A) Chest computed tomography (CT) scan showing no cryptococcosis related lesion. (B) Chest CT scan showing no lymphadenopathy.

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