A Rare Case of Isolated Pulmonary Cryptococcoma in an Immunocompromised Host

Area of Science:

• Medical Mycology
• Infectious Diseases
• Pulmonology

Background:

• Cryptococcosis is an opportunistic fungal infection, particularly common in individuals with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS).
• Isolated pulmonary cryptococcosis presents with varied symptoms and is challenging to diagnose due to its rarity.
• Early recognition and diagnosis are crucial for effective management of cryptococcal infections.

Observation:

• A 54-year-old female with poorly controlled HIV presented with seizure-like activity and was found to have a CD4 count of 7.
• Initial symptoms of fever and headache led to suspicion of cryptococcal meningitis, with empirical treatment initiated.
• Cranial CT was negative, but serum cryptococcal antigen was positive; however, cerebrospinal fluid studies were negative for fungal presence.

Findings:

• Thoracic CT revealed new solid pulmonary nodules in the right upper lobe, with no other signs of disseminated disease.
• A CT-guided biopsy confirmed the presence of Cryptococcus species in the pulmonary nodules.
• Despite positive serum antigen, cerebrospinal fluid analysis and other cultures were negative, indicating localized pulmonary disease.

Implications:

• This case demonstrates that Cryptococcal disease can remain localized even with a positive serum cryptococcal antigen.
• It underscores the necessity of comprehensive investigations using diverse diagnostic modalities to detect disseminated cryptococcosis.
• Prompt and accurate diagnosis, especially in immunocompromised patients, is vital for successful treatment outcomes and preventing complications.