A case of pulmonary cryptococcosis mimicking pulmonary tuberculosis in a healthy young man
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Cryptococcosis is a common opportunistic infection in patients with acquired immunodeficiency syndrome and other causes of reduced immunity. Majority of pulmonary cryptococcosis patients exhibiting non specific clinical manifestations. So diagnosis of pulmonary cryptococcosis in patients without underlying diseases is generally difficult. Especially in an area with a high prevalence of pulmonary tuberculosis and when it shows cavitary lesion, pulmonary cryptococcosis is likely to be misdiagnosed as a pulmonary tuberculosis. We present here a case of pulmonary cryptococcosis that mimicked pulmonary tuberculosis in an immunocompetent patient. A 29 -year- old man presented with a 4 -day history of productive cough, low grade fever and left pleuritic chest pain. The serum anti-HIV antibody was negative. A chest X-ray showed patchy infiltration on the left upper lung field. Computed tomography (CT) showed segmental consolidation in the anterior segment of the left upper. The examination of the sputum for acid-fast bacilli with gram staining and culture did not reveal any organisms. Four days later the patient respiratory symptoms was aggravated. A follow-up chest CT demonstrated progression of the segmental consolidation with cavitation and necrosis. We conducted bronchoalveolar lavage and fluid culture was negative and there were neither acid-fast bacilli nor any pathogens. To get a tissue specimen, we conducted ultrasonography guided percutaneous needle aspiration. The specimen exhibited multiple areas of granulomatous inflammation and round, yeast-like bodies. Mucicarmine stain for the capsular material was incompletely positive and the Fontana-Masson silver stain was negative. The tissue fungal culture did not grow Cryptococcus. The result of the serum cryptococcal antigen test was positive, with a titer of 1:256. The result of the histology and the high titer of SCA strongly suggested pulmonary cryptoccosis, so we conducted polymerase chain reaction (PCR) for the tissue and the PCR from the tissue specimen was positive for cryptoccosis. Treatment with 400 mg/d of oral fluconazole for 9-month course was initiated. At the end of treatment, pulmonary lesions were improved on the follow-up CT.
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