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Weekly Chest CasesArchive of Old Cases

Case No : 368 Date 2004-11-13

  • Courtesy of Kun Young Lim, M.D., Chang Hyun Lee, M.D., Hyun Ju Lee, M.D., Jin Mo Goo, M.D., Jung-Gi Im, M.D. / Seoul National University Hospital, Seoul, Korea
  • Age/Sex 58 / M
  • Chief ComplaintChest abnormality, known AIDS patient
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Cryptococcosis in AIDS patient
Radiologic Findings
Chest simple radiograph shows small nodular opacity in the left lower lung field.

On follow-up chest radiograph three months later, the size of nodule in left lower lung field increased.

Chest CT scans with lung window setting show multiple small nodules in right middle lobe and both lower lobes.

Percutaneous needle aspiration was performed. The pathologic diagnosis was cryptococcal infection.

Two years ago, he diagnosed as cryptococcal meningitis.

Brain MRI obtained two years ago. Enhance T1 weighted axial images show leptomeningeal enhancement in right parasagittal area and posterior fossa.
Brief Review
Cryptococcus neoformans is a ubiquitous fungus found worldwide, particularly in soil contaminated by pigeon droppings. It is a thin-walled nonmycelial budding yeast that is characterized by a thick polysaccharide capsule best seen on India ink preparations.
Cryptococcal infection usually results from inhalation of organisms; dependent on host immune status, the infection may remain isolated to the lungs or undergo hematogenous spread to involve the CNS, bones, and skin. Pulmonary cryptococcosis occurs rarely in immunocompetent individuals. Defects in cellular immune function predispose to infection, with susceptible patient groups including those with HIV infection, lymphoma, leukemia, malignancy, and drug-induced immunosuppression.
The radiographic manifestations of pulmonary cryptococcosis have been described to occur in three major patterns: solitary pulmonary nodule or mass, segmental or lobar consolidation, and small nodular or reticulonodular pattern. Associated findings may include cavitation, lymphadenopathy, and pleural effusion. Cavitation occurs in approximately 10% of nodules. Diffuse involvement, including military pattern, lymph node enlargement, and cavitation, is seen commonly in immunosuppressed patients.
References
1. Zinck SE, Leung AN, Frost M, Berry GJ, Muller NL. Pulmonary cryptococcosis: CT and pathologic findings. J Comput Assist Tomogr. 2002 ;26:330-4.

2. Lacomis JM, Costello P, Vilchez R, Kusne S. The radiology of pulmonary cryptococcosis in a tertiary medical center. J Thorac Imaging. 2001 ;16:139-48. 3. Muller NL, Fraser RS, Lee KS, Johkoh T. Diseases of the lung. Philadelphia: Lippincott Wiliams & Wilkins, 2003:56-57.
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 34

▶ Correct Answer : 19/34,  55.9%
  • - Annecy Hospital, France Gilles Genin
  • - ASL Bologna Ospedale, Maggiore, Italy Marcellino Burzi
  • - CH lyon sud, France Xavier Riviere
  • - CHU Nancy-Brabois, France Denis Regent
  • - CIM Saint Dizier, France JC Leclerc
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Ewha Woman's University Hospital, Korea Yoo Kyoung Kim
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Guri Hospital, Korea Hyunji Kim
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Leeds General Infirmary, UK Girish Raghunathan
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Nancy, France Julien Mathias
  • - National Taiwan University Hospital, Taiwan Tan Che Kim
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Sharma Clinic, Jaipur, India Dinesh Sharma
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
▶ Semi-Correct Answer : 4/34,  11.8%
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Govt. Medical College, Vadodara , India Vijay Vaidya
  • - Hangang sacred heart hospital, Korea Young-Jae Kim
  • - Hanyang University Hospital, Seoul, Korea Son Youl Lee
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