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pulmonary cryptococcosis

Tuesday 18 May 2010

Digital cases

- JRC:419 : Pulmonary cryptococcosis.
- JRC:421 : Pulmonary cryptococcosis.

Images

- pulmonary cryptococcosis

Definition: Pulmonary cryptococcosis is the consequence of the inhalation of Cryptococcus neoformans, an encapsulated yeast, from various environmental sources.

It is commonly accepted that the acquisition of the disease occurs early in life and that the disease is mostly related to a reactivation from a pulmonary site in immunocompromised hosts such as patients infected with human immunodeficiency virus.

Clinical and radiological presentations of the disease are nonspecific and are more severe in immunocompromised hosts with acquired immunodeficiency syndrome (AIDS).

However, fulminant forms have also been reported in apparently immunocompetent hosts. C. neoformans has rarely been responsible for colonization of the respiratory tract; this usually occurs in immunocompetent hosts with preexisting pulmonary disease.

Diagnosis of pneumonia is obtained by either analysis of bronchoalveolar lavage in AIDS patients or by the histology/mycological analysis of a pulmonary nodule.

In any case, a careful work-up for diagnosing dissemination should always be performed.

Antifungal treatment has to be given in most of the immunocompetent hosts and always in those with any kind of immunodeficiency with isolated pulmonary cryptococcosis.

Pulmonary cryptococcosis should therefore be considered in the differential diagnosis of a lung mass, even in an immunocompetent host, especially if the clinical history reveals recent travel in regions where Cryptococcus sp. is endemic.

Variants

- cryptococcal inflammatory pseudotumors (19937947, 17895752)

  • Cryptococcal inflammatory myofibroblastic tumors have been in the lung and in the setting of an immunocompetent host.

See also

- cryptococcoses / cryptococcosis

  • localized cryptococcosis
  • systemic cryptococcosis

- inflammatory pseudotumors

- Mycoses

References

- A rare case of pulmonary cryptococcal inflammatory myofibroblastic tumor diagnosed by fine needle aspiration cytology. Kushner YB, Brimo F, Schwartzman K, Auger M. Diagn Cytopathol. 2009 Nov 24. PMID: 19937947

- Sing Y, Ramdial PK. Cryptococcal inflammatory pseudotumors. Am J Surg Pathol. 2007 Oct;31(10):1521-7. PMID: 17895752