A Case of Pulmonary Cryptococcosis by Capsule-deficientCryptococcus neoformans

Abstract

Pulmonary infection by capsule-deficient Cryptococcus neoformans (CDCN) is a very rare form of pneumonia and it is seldom seen in the immunocompetent host. The authors experienced a case of pulmonary cryptococcosis by CDCN in 25-year-old woman who was without any significant underlying disease. The diagnosis was made from the percutaneous lung biopsy and special tissue staining, including Fontana-Masson silver (FMS) staining. Fungal culture confirmed the diagnosis afterward. Her clinical and radiologic features improved under treatment with fluconazol. It's known that CDCN is not so readily confirmed because fungal culture does not always result in growth of the organism and the empirical fungal stain is not helpful for the differentiation between CDCN and the other infections that are caused by the nonencapsulated yeast-like organisms. In this report, we emphasize the diagnostic value of performing FMS staining for differentiating a CDCN infection from the other confusing nonencapsulated yeast-like organisms.

Unusual morphologies of Cryptococcus spp. in tissue specimens: report of 10 cases

“…The loss of capsule material elicits an intense inflammatory response that includes early suppuration, phagocytosis and granuloma formation 8,20,24 . Previous reports described cryptococcosis caused nonencapsulated forms as extremely rare, and with no apparent incidence in humans 3,9 . In contrast, considering all of the features described above, a final diagnosis of capsule-deficient cryptococcosis was made in 80% (8/10) of our cases.…”

Diagnostic Challenges ofCryptococcus neoformansin an Immunocompetent Individual Masquerading as Chronic Hydrocephalus

“…Host mechanisms such as IL18 production can downregulate GXM, reduce fungal burden, and may contribute to a hypocapsular phenotype [ 20 ]. Reports of acapsular C. neoformans have been reported with pulmonary disease [ 21 ], septic arthritis [ 22 ], and meningoencephalitis [ 23 – 25 ].…”

Treatment of Indolent, Nonencapsulated Cryptococcal Meningitis Associated with Hydrocephalus

“…In addition to fungal meningitis, there have also been isolated case reports of nonencapsulated Cryptococcus causing pulmonary infection in an immunocompetent host. 4 Symptoms are usually consistent with an indolent pneumonia. The symptoms of cryptococcal meningitis include headache, mental status changes, cranial nerve abnormalities (optic atrophy, extraocular palsy, hearing loss), meningeal signs, and fever.…”