Pulmonary cryptococcoma: a rare and challenging diagnosis in immunocompetent patients.
Cryptococcal infection is commonly seen in immunocompromised patients, although immunocompetent patients may also be infected. The pathogen's portal of entry is the respiratory tract; however, the central nervous system is predominantly involved. Pulmonary involvement varies from interstitial and alveolar infiltrations to large masses, which are frequently first interpreted as lung neoplasm. The diagnosis of pulmonary cryptococcosis, in these cases, is frequently challenging, which, in most cases, requires histopathological examination. The authors report the case of a young female patient who presented a 20-day history of chest pleuritic pain and fever at the onset of symptoms. HIV serology was negative and CD4 count was normal. The imaging work-up was characterized by a huge opacity in the left inferior pulmonary lobe with a wide pleural base. Computed tomography showed a heterogeneous mass involving the bronchial tree. Mediastinal involvement was poor, and there was a splenomegaly. The patient underwent an exploratory thoracotomy and inferior lobectomy. The histopathological examination revealed a cryptococcoma. As the serum antigenemia was positive, the patient was scheduled for long-term treatment with fluconazole. The authors call attention to including the cryptococcal infection in the differential diagnosis of lung mass, mainly when localized in the lung bases in immunocompetent patients.
Internal Medicine Department - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil .
Nicole
N
Haddad
Infectious Disease Department - Instituto Emilio Ribas, São Paulo/SP - Brazil .
Marina Costa
MC
Cavallaro
Infectious Disease Department - Instituto Emilio Ribas, São Paulo/SP - Brazil .
Mariana Pezzute
MP
Lopes
Infectious Disease Department - Instituto Emilio Ribas, São Paulo/SP - Brazil .
Johana Marlen Jerias
JM
Fernandez
Internal Medicine Department - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Lorena Silva
LS
Laborda
Surgical Clinic Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
José Pinhata
JP
Otoch
Anatomy Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
Cristiane Rubia
CR
Ferreira
Cryptococcus; Lung diseases; Pulmonary Surgical Procedures; Therapeutics