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Pulmonary cryptococcoma presenting as endobronchial mass mimicking malignancy in immunocompetent host.

Gupta HR, Ahmed AM, Yadav BR, Mutha S - Lung India (2015 Sep-Oct)

View Article: PubMed Central - PubMed

Affiliation: Department of General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India E-mail: drayaz.ahmed@yahoo.com.

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Sir, Pulmonary fungal infection in an immunocompetent host is very rare... This patient had X ray chest suggestive of collapse with consolidation... He was diagnosed as case of unresolved pneumonia... Cough was nonproductive without hemoptysis... On auscultation of chest vesicular sounds were decreased on the left side with bronchial breathing and few crepts... In the chest it has a wide range of presentation starting from asymptomatic colonization of airways (where the patient are detected by abnormal chest radiograph to life-threatening pneumonia and acute respiratory distress syndrome (with symptoms of fever, cough, chest pain)... Cases of cryptococcal pneumonia with fatal outcome in immunocompetent patients, though unusual, have been reported... Cryptococcal meningitis has the typical features of meningitis like headache and recurrent vomiting and are more pronounced in HIV patients... This case history implies to keep one of the possibility of cryptococcoma in the case of endobronchial mass irrespective of patient's HIV status... Cryptococcocal meningitis can occur in immunocompetent individual and microscopic CSF examination can be diagnostic.

No MeSH data available.


Related in: MedlinePlus

HRCT thorax shows mass in left mediastinum with collapse and consolidation of the left lung
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Figure 2: HRCT thorax shows mass in left mediastinum with collapse and consolidation of the left lung

Mentions: A young married male was referred to our hospital with history of cough, fever and breathlessness since last 4 months. He was non-diabetic, nonalcoholic and nonsmoker. No past history of tuberculosis or use of steroids. There was a history of loss of appetite with objective loss of weight (as the pant he was wearing was loosened out at the waist). Cough was nonproductive without hemoptysis. On auscultation of chest vesicular sounds were decreased on the left side with bronchial breathing and few crepts. Chest X ray postero-anterior view showed an area of consolidation with collapse of entire left lung [Figure 1]. HRCT thorax showed large mass 5.4 × 4.4 cm in left hilar region causing collapse of left lung with adjacent lymphadenopathy and consolidation patches raising possibility of malignancy [Figure 2]. PET CT whole body was done which showed hypermetabolic left bronchial mass and left hilar lymph nodes. Further to confirm diagnosis bronchoscopy with bronchoalveolar lavage was done. Bronchoscopy revealed polypoidal mass in left main bronchus with slough. Biopsy of mass showed encapsulated budding yeast cells suggestive of C.neoformans. BAL showed fungal elements consistent with Cryptococcus, no malignant cells. Cerebrospinal fluid examination was done to look for disseminated cryptococcosis which requires aggressive treatment. Total leukocyte count was raised-15,000/cumm, other hematological parameters were normal. ELISA for HIV1 and HIV 2 was negative. The patient was started on injection amphotericin B (25 mg/day increased upto 60 mg/day for 6 weeks followed by oral flucanozole 400 mg/day for 10 weeks) to which he responded and chest x ray showed resolution [Figure 3].


Pulmonary cryptococcoma presenting as endobronchial mass mimicking malignancy in immunocompetent host.

Gupta HR, Ahmed AM, Yadav BR, Mutha S - Lung India (2015 Sep-Oct)

HRCT thorax shows mass in left mediastinum with collapse and consolidation of the left lung
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587023&req=5

Figure 2: HRCT thorax shows mass in left mediastinum with collapse and consolidation of the left lung
Mentions: A young married male was referred to our hospital with history of cough, fever and breathlessness since last 4 months. He was non-diabetic, nonalcoholic and nonsmoker. No past history of tuberculosis or use of steroids. There was a history of loss of appetite with objective loss of weight (as the pant he was wearing was loosened out at the waist). Cough was nonproductive without hemoptysis. On auscultation of chest vesicular sounds were decreased on the left side with bronchial breathing and few crepts. Chest X ray postero-anterior view showed an area of consolidation with collapse of entire left lung [Figure 1]. HRCT thorax showed large mass 5.4 × 4.4 cm in left hilar region causing collapse of left lung with adjacent lymphadenopathy and consolidation patches raising possibility of malignancy [Figure 2]. PET CT whole body was done which showed hypermetabolic left bronchial mass and left hilar lymph nodes. Further to confirm diagnosis bronchoscopy with bronchoalveolar lavage was done. Bronchoscopy revealed polypoidal mass in left main bronchus with slough. Biopsy of mass showed encapsulated budding yeast cells suggestive of C.neoformans. BAL showed fungal elements consistent with Cryptococcus, no malignant cells. Cerebrospinal fluid examination was done to look for disseminated cryptococcosis which requires aggressive treatment. Total leukocyte count was raised-15,000/cumm, other hematological parameters were normal. ELISA for HIV1 and HIV 2 was negative. The patient was started on injection amphotericin B (25 mg/day increased upto 60 mg/day for 6 weeks followed by oral flucanozole 400 mg/day for 10 weeks) to which he responded and chest x ray showed resolution [Figure 3].

View Article: PubMed Central - PubMed

Affiliation: Department of General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India E-mail: drayaz.ahmed@yahoo.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Pulmonary fungal infection in an immunocompetent host is very rare... This patient had X ray chest suggestive of collapse with consolidation... He was diagnosed as case of unresolved pneumonia... Cough was nonproductive without hemoptysis... On auscultation of chest vesicular sounds were decreased on the left side with bronchial breathing and few crepts... In the chest it has a wide range of presentation starting from asymptomatic colonization of airways (where the patient are detected by abnormal chest radiograph to life-threatening pneumonia and acute respiratory distress syndrome (with symptoms of fever, cough, chest pain)... Cases of cryptococcal pneumonia with fatal outcome in immunocompetent patients, though unusual, have been reported... Cryptococcal meningitis has the typical features of meningitis like headache and recurrent vomiting and are more pronounced in HIV patients... This case history implies to keep one of the possibility of cryptococcoma in the case of endobronchial mass irrespective of patient's HIV status... Cryptococcocal meningitis can occur in immunocompetent individual and microscopic CSF examination can be diagnostic.

No MeSH data available.


Related in: MedlinePlus