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Weekly Chest CasesArchive of Old Cases

Case No : 1046 Date 2017-11-13

  • Courtesy of Jin Young Kim, Suyon Chang, Hye-Jeong Lee / Severance Hospital
  • Age/Sex 66 / F
  • Chief ComplaintCough, chest discomfort for 1month. Underlying hypertension, diabetes mellitus, and HBV carrier
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Pulmonary cryptococcosis
Radiologic Findings
PA chest radiograph demonstrates mass- like consolidation in the left lower lung field. Contrast enhancement CT scan of the chest demonstrates multiple ill-defined nodules and masses with surrounding ground glass opacities in the left lower lobe, associated with minimal amount of bilateral pleural effusions. There were no significant enlarged lymph nodes in the mediastinum.
CT-guided gun biopsy was done at the left lower lobe lesion, and the Periodic acid-Schiff (PAS) and Methenamine silver (GMS) stain revealed many cryptococcal yeasts within the mass. The patients serum cryptococcal antigen was also positive.
The final diagnosis was pulmonary cryptococcosis.
Brief Review
Cryptococcus neoformans is an encapsulated yeast that is found worldwide, particularly in the soil contaminated with pigeon excreta and decayed wood (1). Human infection occurs via inhalation of cryptococcal particles into the lungs (1). Cryptococcal infection can occur in individuals with normal immunity, but is more common in immunocompromised hosts, especially in human immunodeficiency virus (HIV) carriers and recipients of organ transplants. Immunocompromised patients develop a greater extent of pulmonary abnormalities than immunocompetent patients (2).
Radiological presentations of pulmonary cryptococcosis are variable. Previous studies (3) have shown that solitary or multiple subpleural nodules are common on CT scans in non-AIDS pulmonary cryptococcosis. Consolidations and pleural effusions with occasional mediastinal lymph node enlargement, although not common, are found in some cases (4). Lesions are mainly located in the middle and lower lung fields or diffusely distributed throughout the entire lung (3). Recommended treatment of pulmonary cryptococcosis in immunocompetent patients is fluconazole.
Please refer to
Case 987, Case 964, Case 945, Case 891, Case 862, Case 842, Case 831, Case 817, Case 770, Case 754, Case 671, Case 603, Case 512, Case 446, Case 388, Case 382, Case 282, Case 231, Case 181,
KSTR Imaging conference 2009 Summer  Case 16, Case ,
Thoracic Imaging 2003- Korean & Japanese Film Interpretation -  Case 5, Case ,
KSTR Imaging Conference 2001 Spring  Case 6,
References
1. Jarvis JN, Harrison TS. Pulmonary cryptococcosis. Seminars in respiratory and critical care medicine. 2008;29(2):141-50.
2. Chang WC, Tzao C, Hsu HH, Lee SC, Huang KL, Tung HJ, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest. 2006;129(2):333-40.
3. Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 2005;236(1):326-31.
4. Yu JQ, Tang KJ, Xu BL, Xie CM, Light RW. Pulmonary cryptococcosis in non-AIDS patients. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases. 2012;16(6):531-9.
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 79

▶ Correct Answer : 31/79,  39.2%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Other , Korea (South) SEONG SU KANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - 怨„紐… , Korea (South) jin young kim
  • - , Brazil MARCEL KOENIGKAM SANTOS
  • - Other , Korea (South) HAYEON LEE
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Gifu University , Japan KEITA FUJIMOTO
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Katoh-gazou-shindan , Japan SHOICHI KATOH
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 15/79,  19.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - Seoul National University Hospital , Korea (South) JAE WON CHOI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Ajou University Hospital , Korea (South) YONG HO JANG
▶ Semi-Correct Answer : 14/79,  17.7%
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Seoul National University Hospital , Korea (South) HAN SEUNGCHUL
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Seoul National University Bundang Hospital , Korea (South) YOUNGJUNE KIM
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Sarawak General Hospital , Malaysia POHSEN TAY
  • - Max Hospital New Delhi , India RAJESH GOTHI
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Fortis hospital , Mohali , India SHALEEN RANA
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