Pulmonary cryptococcosis mimicking lung cancer

A 77-year-old man with no history of smoking presented to a clinic with a cough and low-grade fever. He had a history of right pneumothorax and rib fracture. CT imaging showed a shadow of a mass in his right lung and cancer was suspected (figure). He was admitted to our hospital for further assessment. Serum concentrations of the lung tumour markers carcinoembryonic antigen (3·3 ng/mL), cytokeratin 19 fragment (1·6 ng/mL), and progastrin-releasing peptide (31·7 pg/mL) were not increased; however, cryptococcal antigen was detected with a latex agglutination test. The man underwent 18F-fluoro-deoxyglucose PET, and high uptake was detected at the mass. A bronchoscopic examination was done. Pathologically, he was diagnosed with pulmonary crypto-coccosis, and no tumour cells were detected. Standard antifungal therapy for pulmonary cryptococcosis to improve prognosisMasaya Taniwaki and colleagues1 report an interesting case of pulmonary cryptococcosis mimicking lung cancer. The patient was confirmed to have pulmonary cryptococcosis through both bronchoscopic examination and CT-guided biopsy. After antifungal treatment for several days, the mass in the lungs had not decreased in size and the patient refused to continue therapy, continuing only with observation. After a discussion about the antifungal therapy given and a review of the literature, we concluded that the effect of therapy might have been more obvious if standard treatment had been given. Full-Text PDF Standard antifungal therapy for pulmonary cryptococcosis to improve prognosis – Authors' replyWe thank Boyou Zhang and colleagues for their interest in and comments on our Clinical Picture.1 To the best of our knowledge, our patient was not immunosuppressed because none of the following causes of immunosuppression were present: HIV infection, human T-cell leukaemia virus type 1 infection, immunosuppressive drugs, malignant diseases, diabetes, splenectomy, renal disease, or liver disease. Full-Text PDF