Discussion
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,