Pulmonary nodules are frequently considered to be a metastatic disease or primary lung tumors in oral cancer patients. We present a case of pulmonary cryptococcosis in a 68-year-old man with oral and lung cancer. This lung cancer was treated with thoracoscopic resection of the right inferior lobe and mediastinal lymph node dissection. Lower gingival cancer was treated with a mandibulectomy, neck dissection, and reconstruction after chemoradiotherapy. A 20 mm cavitary nodule appeared at the left lung S6 one-month after surgery, during post-operative computed tomography. Thoracoscopic partial resection of the left inferior lobe was performed under the suspicion of lung metastasis. Pathology results revealed a pseudo-epithelial granuloma with necrosis and many yeast-shaped fungi with capsules. A pathological diagnosis of Cryptococcus infection was made. The patient was prescribed the antifungal agent fosfluconazole, which was administered intravenously for 1 week and intraoral fluconazole for 12 months. No recurrence of the Cryptococcus infection has been noted after 1.5 years.
Abstract
Background: The use of immunosuppressors and a relatively weaken cell-mediated immunity make organ transplant recipients particularly vulnerable to cryptococcosis infection. Patients infected usually present only nonspecific symptoms, making it extremely possible for misdiagnosis and inappropriate choice of therapeutic approach. Methods: We compiled and analysed data of patients received kidney transplant in our hospital between April 2006 to January 2021. Results: 18 patients were enrolled into the study, ranging between 27-68 years old. The median time from kidney transplantation to pathologically-confirmed infection was 4.09 years. All patient’s respiratory system was affected, showing symptoms including sputum-producing cough and fever. 3 patients (16.67%) also developed central nervous system (CNS) infections. Nodule-shaped infectious sites were frequently observed (10, 58.82%) in chest CT. Blood works showed no specific changes. 7 patients received thoracoscopic lobectomy in suspicion of lung cancer. 3 patients first received antifungal therapy for a period of time and then underwent thoracoscopic lobectomy. No recurrence whatsoever was observed in all 10 surgically-intervened patients. 8 patients received only antifungal therapy, 7 of them showed a substantial reduction in the size of the infectious site. Fluconazole was most frequently prescribed for antifungal therapy. Conclusion: Most patients developed pulmonary cryptococcosis 2 years after transplantation. Patients usually demonstrate symptoms like fever and sputum-producing cough. The possibility of cryptococcal meningitis shouldn’t be ruled out if corresponding symptoms occur. CT presentation may be confused with lung cancer. Fluconazole is commonly prescribed for treatment and can usually yield satisfied outcome. In patients received unsatisfactory antifungal therapy, surgical therapy should be considered a possibility.
Pulmonary cryptococcosis mimicking lung cancer
