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

• Kim YS
• Lee IH
• Kim HS
• Jin SS
• Lee JH
• Kim SK
• Song SH
• Yoo J
• Kim CH
• Kwon SS

• KMID: 1842915
• DOI: http://doi.org/10.4046/trd.2012.73.3.182

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.

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  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.

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  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).

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  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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