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WORD COUNT: MAIN TITLE--CRYPTOCOCCAL PNEUMONIA: THE GREAT MIMICKER Cryptococcal pneumonia: A diagnostic challenge
CASE REVIEW
LASYA THAMBIDURAI1. M.D, FRCR
[email protected] PRABHURADHAN.R1. M.D.,
[email protected] PRAVEEN KUMAR SINGHVI1 M.D., DNB,
[email protected] ILANCHEZHIAN S1 M.D, FRCR
[email protected] RAJOO RAMACHANDRAN1 M.D.,
[email protected] HAREESHANKAR1 MBBS
[email protected] 1
Sri Ramachandra Medical College and Hospital, Porur, Chennai-116
CORRESPONDING AUTHOR: LASYA THAMBIDURAI No 1, Ramachandra Nagar, Porur Chennai-116
[email protected]
CONFLICT OF INTEREST: No conflict of interest exists between the specified authors
Manuscript
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MAIN TITLE--CRYPTOCOCCAL PNEUMONIA: THE GREAT MIMICKER Cryptococcal pneumonia: A diagnostic challenge
SUMMARY Cryptococcal pneumonia is a fungal infection caused by Cryptococcus neoformans predominantly in the immuno-suppressed individuals and rarely in immuno-competent population. In this study we describe the varied radiological presentations in three patients, both immuno-suppressed and immuno-competent individuals. The varied imaging presentations pose a great challenge for the radiologist and the clinician. The imaging findings mimic other diseases and it might make the diagnosis difficult purely on radiological features alone. Hence image guided biopsies and further evaluation is essential for confirmation of diagnosis
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Cryptococcal pneumonia is a fungal infection caused by Cryptococcus neoformans predominantly in the immuno-suppressed individuals and rarely in immuno-competent population1-3. Pulmonary cryptococcal infection is more common in immunosuppressed population, including AIDS patients, diabetics, patients on immunosuppressive therapy etc. It is caused by the inhalation of the fungal spores1-5. There are two varieties of C. neoformans: var neoformans and var gattii. The infection is initially localised and becomes disseminated depending on the immune status of the individual. Pulmonary cryptococcosis in AIDS/immunosuppressed patients tends to manifest itself as a disseminated thoracic disease with an interstitial lung pattern and lymph node enlargement6, 7. In immunocompetent individuals the infection tends to be more indolent with imaging manifestations range from single or multiple nodular lesions or mass-like consolidation8, 9, 10. The diagnosis is based on pathological findings (lymph node sampling, image guided biopsies). The histopathological diagnosis was rendered by identifying encapsulated yeast forms within inflammatory lung tissue. Serum cryptococcal antigen test and bronchoalveolar lavage with culture can also be performed for diagnosis. Antifungal therapy is the mode of treatment; however, few patients might need resection depending on the severity. Here we discuss the varied radiological manifestations of Cryptococcal pneumonia in three patients (immuno-suppressed and immuno-competent) CASE 1: A 40 yr old immunosuppressed man, diagnosed with AIDS presented with complaints of cough, fever. Initial chest x ray showed nodular opacities in bilateral lung fields (Figure 1). Plain CT (Computed tomography) showed multiple small (
