대한흉부영상의학회 Weekly Chest Cases

Case No : 862 Date 2014-05-05

Courtesy of Yo Won Choi / Hanyang University Hospital
Age/Sex 53 / F
Chief ComplaintCough for 4 months, Hx of thyroidectomy and radioactive iodine therapy due to thyroid cancer (14 months ago)

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before 1 year

Diagnosis With Brief Discussion

Diagnosis: BOOP associated with cryptococcosis
Radiologic Findings: A chest radiograph taken a year before was normal. Chest radiograph and CT taken at the time of presentation show multiple nodular consolidations and internal air bronchogram especially in the periphearl area of both lower lung zones.
Open lung biopsy revealed findings of organizing pneumonia but no causitive oraganism. Serum cryptococcal antigen test was positive, confirming the diagnosis of pulmonary cryptococcosis.
Brief Review: The most common radiographic manifestation of cryptococcosis includes single or multiple pulmonary nodules, usually in the upper lobes. Other pathologic manifestations, more frequent in the immunocompromised patient, include parenchymal consolidations in all parts of lung, pulmonary nodules that may cavitate, interstitial infiltrates, or disseminated miliary pulmonary disease. Pleural effusions and hilar or mediastinal lymphadenopathy are uncommon. Organizing pneumonia due to Cryptococcus has rarely been described (1).
organizing pneumonia is usually idiopathic but has been associated with pulmonary infections, toxic fumes, connective tissue disorders, drug reactions, allergic reactions, and receipt of a transplant. Carey et al reported a case of OP associated with pulmonary cryptococcosis. Infection causing secondary OP includes Haemophilus influenzae, Bordetella pertussis, Legionella pneumophila, Nocardia species, Coxiella burnetii, adenovirus, and respiratory syncytial, influenza, parainfluenza, varicella-zoster, and measles virses (2).
The clinical course of OP is usually insidious; symptoms are present for several weeks to months before diagnosis. Pulmonary cryptococcosis is often difficult to diagnose and often mimics other diseases. Sputum cultures are rarely helpful, and serum cryptococcal antigen screening is specific but not sensitive (2).
References: 1. Kessler AT et al. Cryptococcus neoformans as a cause of bronchiolitis obliterans organizing pneumonia. Journal of Infection and Chemotherapy 2010;16:206 -209
2. Carey CF et al. Bronchiolitis Obliterans-Organizing Pneumonia Associated with Cryptococcus neoformans Infection. Clin Infect Dis 1991; 13:1253 -1254
Keywords: Lung, Infection, Fungal infection,

No. of Applicants : 88

▶ Correct Answer : 4/88, 4.5%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- GHICL , France manuel toledano
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 40/88, 45.5%

- Niigata City General Hospital , Japan Takao Kiguchi
- Goa Medical College , India Paresh Desai
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Kyoto University , Japan Akihiko Sakata
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- Seoul National University Hospital , Korea (South) YongSub Song
- Government Medical College, Nagpur, India , India Krishna Prasad Bellam
- IRSA La Rochelle , France Denis Chabassiere
- UWO , Canada S Lee
- Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
- Asan medical center , Korea (South) Sang Young Oh
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Kanto Rosai Hospital , Japan tomoko sako
- ICD,MCH CALICUT , India rikhy krishnan
- Kizawa Memorial Hospital , Japan Yo Kaneko
- 異⑸ , Korea (South) Yunhee Jang
- 異⑸ , China ZHANG YING
- Chungbuk national university , Korea (South) YongHun Kim
- chungbuk national university hospital , Korea (South) soojung lee
- 異⑸ , Korea (South) Junghwan Kim
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Japanese national center hospital of neurology and psychiatry , Japan Kaoru Sumida
- district tuberculosis centre,poonamallee , India gayathri ganesh
- Shiga University of Medical Science , Japan Akitoshi Inoue
- McGill University Health Center , Canada Alexandre Semionov
- CLCC Rennes , France nicolas gautier
- NASA SCANS , India RAKESH BHATIA
- SNUH , Korea (South) Eui Jin Hwang
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- TCM HOSPITAL OF ZIGONG , China Cao Cunyou
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Private sector , Greece Vasilios Tzilas
- CHU POITIERS , France SZTARK Guillaume
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Fukuyama City Hospital , Japan Mayu Uka

▶ Semi-Correct Answer : 14/88, 15.9%

- Hallym University Kangnam Sacred Heart Hospital , Korea (South) Jung Youn Kim
- CHU Poitiers , France CHAN paul
- University of British Columbia , Canada Amr Ajlan
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- NIMS, HYDERABAD , India bhaskar kakarla
- Radiology University of Messina , Italy Michele Gaeta
- Kyoto Prefectural University of Medicine , Japan Hitomi Nagano
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
- Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
- SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
- Konkuk University Medical Center , Korea (South) Inyoung Song
- Onomichi municipal hospital , Japan Hirofumi Mifune
- The University of Tokyo Hospital , Japan Takana Yamakawa

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 862 Date 2014-05-05

Discussion

No. of Applicants : 88