대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Cryptococcal infection in immunocompetent patient

Radiologic Findings

CT shows multiple nodules on the right lung. Some larger nodules have necrosis, cavitation, and air-fluid level. Small spot of calcification is noted on a nodule on the right upper lobe.

Brief Review

Symptoms of pulmonary cryptococcal infection in immunocompetent hosts frequently are absent and the infection often goes unrecognized. When symptoms do occur they are usually indolent, progressing over a course of weeks to months. Symptoms include low-grade fever, cough with or without sputum, chest pain, weight loss, and, rarely, hemoptysis, dyspnea, or night sweats. In most cases, patients with pulmonary cryptococcosis do not become symptomatic until pulmonary lesions have become very large. As a consequence, many cases are found incidentally on chest radiograph or CT. There are 4 primary patterns of radiographic findings in immunocompetent hosts: pulmonary nodules, fungus collections, cryptococcal pneumonia, and disseminated disease. Approximately one third to one half of cases of pulmonary cryptococcosis in immunocompetent hosts are defined by pulmonary nodules, which are usually subpleural, solitary or clustered, and may be confused easily with reactivation tuberculosis. Cavitation and calcification of nodules is rare unlike the case with our patient. Pleural effusions are extremely rare in immunocompetent hosts. In immunocompetent individuals, the natural history of the disease typically results in spontaneous resolution within 1 to 2 months even in the absence of therapy. In immunocompetent patients is probably much higher than that implied by the literature given the tendency of the infection to remain asymptomatic and to resolve spontaneously even in the absence of treatment.

References

Himmel, J. E. and P. Stark. Cryptococcal pneumonia in an immunocompetent host: radiographic findings. Semin Respir Infect 2003;18: 129-31.

Keywords

Lung, Infection, Fungal infection,