Intra-cavitary pulmonary cryptococcoma in poorly controlled diabetes mellitus

Area of Science:

• Pulmonology
• Infectious Diseases
• Mycology

Background:

• Cryptococcoma is a rare fungal infection caused by Cryptococcus species, often presenting as a lung mass or nodule.
• Pulmonary cryptococcoma can mimic other lung diseases like tuberculosis or malignancy, leading to diagnostic challenges.
• Risk factors for cryptococcoma include immunosuppression, but it can occur in immunocompetent individuals.

Observation:

• A 59-year-old HIV-negative Ugandan man with a history of respiratory symptoms and prior tuberculosis treatment presented with a pulmonary lesion.
• Chest imaging revealed an intra-cavitary pulmonary cryptococoma.
• The patient had poorly controlled diabetes mellitus (HbA1c, 9.3%).

Findings:

• Sputum culture confirmed the presence of Cryptococcus.
• Serum cryptococcal antigen and sputum Xpert® MTB RIF Ultra assay for tuberculosis were negative.
• The patient was successfully treated with oral fluconazole.

Implications:

• This case highlights the importance of considering pulmonary cryptococoma in the differential diagnosis of cavitary lung lesions, especially in endemic areas.
• Effective treatment of pulmonary cryptococoma can be achieved with oral fluconazole, even in HIV-negative individuals with comorbidities like diabetes.
• Early and accurate diagnosis is crucial to prevent complications and ensure successful treatment outcomes for this rare fungal infection.