Intralobar pulmonary sequestration coexisting with pulmonary cryptococcosis: A case report and literature review

Pulmonary sequestration (PS) is a rare congenital foregut abnormality characterized by non-functioning lung tissue that receives an arterial blood supply from an anomalous systemic artery, typically the aorta, and is separated from the normal tracheobronchial tree. It often presents as a mass-like, cystic, cavitary or pneumonic lesion on imaging. Patients often present with symptoms of recurrent pulmonary infection; however, cryptococcal infection is rare. The present case study reports on a 52-year-old man with PS and cryptococcal infection. The mass in the lower lobe of the right lung was removed by video-assisted thoracoscopic surgery and diagnosed as PS. Furthermore, the nodule present in the left inferior lobe was identified as cryptococcal infection by percutaneous lung biopsy. Pulmonary cryptococcosis (PC) disappeared after antifungal treatment. During the 3-year follow-up, the patient was in good condition and no recurrence of either disease was observed on contrast-enhanced CT. The present unique case of intralobar PS with a contralateral PC nodule underscores that in the absence of a classic systemic feeding artery on imaging, percutaneous biopsy is a key step in diagnosing PS and excluding malignancy. This demonstrates the necessity for anatomy-driven management strategies, whereby spatially separated pathologies warrant a combined approach of surgical resection for the PS and targeted antifungal therapy for the PC. The definitive exclusion of cryptococcal infection within the resected PS tissue argues for a coincidental coexistence in this immunocompetent host, highlighting the importance of evaluating each lesion independently rather than seeking a unifying diagnosis in complex pulmonary presentations.