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Journal of Medical Case Reports

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Open Access 01-12-2018 | Case report

Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature

Authors: Liyang Li, Liang Zhuang, Jian Zhou, Changzhou Shao

Published in: Journal of Medical Case Reports | Issue 1/2018

Abstract

Background

Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented.

Case presentation

A 52-year-old immunocompetent Han Chinese woman was presented to our emergency department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis, higher pathologic stage, and probably poorer prognosis.

Conclusions

Our patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.

Chang WC, Tzao C, Hsu HH, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest. 2006;129(2):333–40. https://doi.org/10.1378/chest.129.2.333.CrossRef

Campuzano A, Wormley F. Innate immunity against Cryptococcus, from recognition to elimination. J Fungi (Basel). 2018;4:33. https://doi.org/10.3390/jof4010033.CrossRef

Hiraga A, Yatomi M, Ozaki D, et al. Cryptococcosis mimicking lung cancer with brain metastasis. Clin Neurol Neurosurg. 2015;135:93–5. https://doi.org/10.1016/j.clineuro.2015.05.014.CrossRef

Ang SY, Ng VW, Kumar SD, et al. Cryptococcosis mimicking lung carcinoma with brain metastases in an immunocompetent patient. J Clin Neurosci. 2017;35:73–75. https://doi.org/10.1016/j.jocn.2016.09.016.CrossRef

Sun L, Chen H, Shao C, et al. Pulmonary cryptococcosis with trachea wall invasion in an immunocompetent patient: a case report and literature review. Respiration. 2014;87(4):324–8. https://doi.org/10.1159/000357715 CrossRef

Harada T, Hakuma N, Kamimura A, et al. Pulmonary cryptococcosis within a pulmonary carcinoma-review of reported cases. Intern Med. 2006;45(6):369–72. https://doi.org/10.2169/internalmedicine.45.1571 CrossRef

Kawasaki H, Ishikawa K, Kuniyoshi M, et al. Lung adenocarcinoma with coexisting pulmonary cryptococcoma. Jpn J Thorac Cardiovasc Surg. 2004;52(1):21–5. https://doi.org/10.1007/s11748-004-0056-5 CrossRef

Li HY, Lan CQ, Weng H, Chen SX, Lin QH, Huang JB. Analysis of 9 cases of nodular type of pulmonary cryptococcosis with coexisting lung cancer confirmed by pathological examinations [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2017;40:850–854. https://doi.org/10.3760/cma.j.issn.1001-0939.2017.11.010.

Robinson TD, Barnes DJ, Watson GF. Coexistent cryptococcosis and carcinoma within a solitary pulmonary nodule. Aust N Z J Med. 1999;29(4):561–2.CrossRef

10.

Ahn IS, Kim HG, Ryu JS, et al. A case of pulmonary cryptococcosis with non-small cell lung cancer in idiopathic CD4⁺ T-lymphocytopenia. Yonsei Med J. 2005;46(1):173–176. https://doi.org/10.3349/ymj.2005.46.1.173.CrossRef

11.

Yuri T, Kimura A, Yoshizawa K, et al. Pulmonary and meningeal cryptococcosis after corticosteroid therapy for autoimmune hepatitis: coexistence of cryptococci within pulmonary cancer nodule. Case Rep Pathol. 2013;2013:807197. https://doi.org/10.1155/2013/807197 PubMedPubMedCentral

12.

Pappas PG, Perfect JR, Cloud GA, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. 2001;33(5):690–9. https://doi.org/10.1086/322597 CrossRef

13.

Shirley RM, Baddley JW. Cryptococcal lung disease. Curr Opin Pulm Med. 2009;15(3):254–260. https://doi.org/10.1097/MCP.0b013e328329268d.CrossRef

14.

Inaba A, Okada A, Yoshida T, et al. Disseminated cryptococcosis with rapidly growing lung nodules in an end-stage renal disease patient. Intern Med. 2017;56(3):377–80. https://doi.org/10.2169/internalmedicine.56.7438 CrossRef

15.

Liu K, Ding H, Xu B, et al. Clinical analysis of non-AIDS patients pathologically diagnosed with pulmonary cryptococcosis. J Thorac Dis. 2016;8(10):2813–21. https://doi.org/10.21037/jtd.2016.10.36 CrossRef

16.

Nakao M, Muramatsu H, Takahashi T, et al. Cryptococcus gattii genotype VGIIa infection in an immunocompetent Japanese patient: a case report and mini-review. Intern Med. 2016;55(20):3021–4. https://doi.org/10.2169/internalmedicine.55.7175 CrossRef

17.

Orsini J, Blaak C, Tam E, et al. Disseminated cryptococcal infection resulting in acute respiratory distress syndrome (ARDS) as the initial clinical presentation of AIDS. Intern Med. 2016;55(8):995–8. https://doi.org/10.2169/internalmedicine.55.5768 CrossRef

18.

Kanjanapradit K, Kosjerina Z, Tanomkiat W, Keeratichananont W, Panthuwong S. Pulmonary cryptococcosis presenting with lung mass: report of 7 cases and review of literature. Clin Med Insights Pathol. 2017;10:1179555717722962. https://doi.org/10.1177/1179555717722962 CrossRef

19.

Skolnik K, Huston S, Mody CH. Cryptococcal lung infections. Clin Chest Med. 2017;38:451–64. https://doi.org/10.1016/j.ccm.2017.04.007 CrossRef

20.

Chen M, Wang X, Yu X, et al. Pleural effusion as the initial clinical presentation in disseminated cryptococcosis and fungaemia: an unusual manifestation and a literature review. BMC Infect Dis. 2015;15:385. https://doi.org/10.1186/s12879-015-1132-4 CrossRef

21.

Sakamoto A, Hisaoka M. Pulmonary cryptococcosis mimicking a metastasis in a patient with Ewing sarcoma. Respirol Case Rep. 2016;4(5):e181. https://doi.org/10.1002/rcr2.181

22.

Liu X, Jia W, Huang S, et al. A case of pulmonary cryptococcosis with large pericardial effusion diagnosed using cervical lymph node biopsy. Clin Respir J. 2018;12(2):820–3. https://doi.org/10.1111/crj.12581 CrossRef

23.

Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(3):291–322. https://doi.org/10.1086/649858 CrossRef

24.

Tanaka Y, Satomi K. Surgical resection during chemotherapy of pulmonary cryptococcoma in a patient with cryptococcal meningitis. Intern Med. 2017;56(1):91–3. https://doi.org/10.2169/internalmedicine.56.7056 CrossRef

25.

Fisher JF, Valencia-Rey PA, Davis WB. Pulmonary cryptococcosis in the immunocompetent patient-many questions, some answers. Open Forum Infect Dis. 2016;3(3):w167. https://doi.org/10.1093/ofid/ofw167 CrossRef

Title: Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature
Authors: Liyang Li
Liang Zhuang
Jian Zhou
Changzhou Shao
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2018
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-018-1853-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature

Abstract

Background

Case presentation

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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