Limits...
Cryptococcal Pneumonia

Flatau PMF - MedPix (2008)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Cryptococcal Pneumonia

History: A 53-year-old woman presents to the ED with a three month history of a chronic dry cough, malaise, and increasing dyspnea on exertion. Significant medical history included a positive PPD in 1985 which was treated with 1 year of Isoniazid. Other medical history included hypertension and type II diabetes mellitus. She had immigrated to the United States from the Phillipines two decades ago. She denied any history of smoking or alcohol use. She had also visited the Philippines several months ago.

Findings: Chest x-ray demonstrated rounded lobular nodules in the left lower lobe. CT pulmonary angiogram revealed multiple enhancing left lower lobe masses, some with cavitation.

Ddx: 1) Malignancy - Metastatic disease: testicular, ovarian, renal, breast, melanoma and sarcoma - Lymphoma - Benign: hamartomas, papillomatosis, bronchogenic cysts, benign metastasizing leiomyomatosis 2) Infectious - Multiple abscesses - Septic emboli - Granulomatous infections - Viral: varicella, measles - Parasitic: Paragonimus westermani 3) Inflammatory - Wegener’s granulomatosis - Sarcoidosis - Rheumatoid nodules

Dxhow: Bronchioaveolar lavage with fluid culture.

Exam: On examination the patient’s lungs were clear to auscultation. Her heart rate was regular without murmurs, gallops or rubs. Neurologic examination was normal. Her room air resting SaO2 was 99% which quickly fell to 93% with ambulation. Following imaging, bronchioaveolar lavage was conducted revealing Cryptococcus neoformans on fluid culture. Cell count 1 revealed RBC 386, WBC 133, Neutrophils 9, Lymphocytes 24, and Macrophages 67. Cell count 2 revealed RBC 363, WBC 199, Neutrophils 41, Lymphocytes 24, Macrophages 33, and Eosinophils 2. Culture was negative to all else including aerobic cultures, acid fast bacilli, and fungal smears. Subsequent serum labs revealed a negative ANCA, IgE 64, LDH 586, Eosinophils 0, and negative HIV. Serum Cryptococcal antigen testing was also negative.

No MeSH data available.


Multiple enhancing left lower lobe masses, some with cavitation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX1375&req=5

MPX1375_synpic41149: Multiple enhancing left lower lobe masses, some with cavitation


Cryptococcal Pneumonia

Flatau PMF - MedPix (2008)

Multiple enhancing left lower lobe masses, some with cavitation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1375&req=5

MPX1375_synpic41149: Multiple enhancing left lower lobe masses, some with cavitation

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Cryptococcal Pneumonia

History: A 53-year-old woman presents to the ED with a three month history of a chronic dry cough, malaise, and increasing dyspnea on exertion. Significant medical history included a positive PPD in 1985 which was treated with 1 year of Isoniazid. Other medical history included hypertension and type II diabetes mellitus. She had immigrated to the United States from the Phillipines two decades ago. She denied any history of smoking or alcohol use. She had also visited the Philippines several months ago.

Findings: Chest x-ray demonstrated rounded lobular nodules in the left lower lobe. CT pulmonary angiogram revealed multiple enhancing left lower lobe masses, some with cavitation.

Ddx: 1) Malignancy - Metastatic disease: testicular, ovarian, renal, breast, melanoma and sarcoma - Lymphoma - Benign: hamartomas, papillomatosis, bronchogenic cysts, benign metastasizing leiomyomatosis 2) Infectious - Multiple abscesses - Septic emboli - Granulomatous infections - Viral: varicella, measles - Parasitic: Paragonimus westermani 3) Inflammatory - Wegener’s granulomatosis - Sarcoidosis - Rheumatoid nodules

Dxhow: Bronchioaveolar lavage with fluid culture.

Exam: On examination the patient’s lungs were clear to auscultation. Her heart rate was regular without murmurs, gallops or rubs. Neurologic examination was normal. Her room air resting SaO2 was 99% which quickly fell to 93% with ambulation. Following imaging, bronchioaveolar lavage was conducted revealing Cryptococcus neoformans on fluid culture. Cell count 1 revealed RBC 386, WBC 133, Neutrophils 9, Lymphocytes 24, and Macrophages 67. Cell count 2 revealed RBC 363, WBC 199, Neutrophils 41, Lymphocytes 24, Macrophages 33, and Eosinophils 2. Culture was negative to all else including aerobic cultures, acid fast bacilli, and fungal smears. Subsequent serum labs revealed a negative ANCA, IgE 64, LDH 586, Eosinophils 0, and negative HIV. Serum Cryptococcal antigen testing was also negative.

No MeSH data available.