Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings in 12 Patients

Fox, Dov; Müller, Néstor L.

doi:10.2214/ajr.185.3.01850622

Cited by 87 publications

(74 citation statements)

References 27 publications

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“…Surrounding groundglass opacity or the CT halo sign, as found in our study, and isolated groundglass opacity (6,(8)(9)(10)(11)17) can be observed. Although centrilobular or satellite nodules have been described (6,8), tree-inbud appearance was observed neither in the present nor in previous studies (6)(7)(8)(9). Therefore, we suggest that the presence of nonenhanced low-attenuation areas within the areas of consolidation or mass having peripheral, subpleural and lower lung predominance, as shown in the present study, should raise the concern for pulmonary cryptococcosis, particularly in a patient presenting with meningitis.…”

Section: Discussionsupporting

confidence: 81%

“…Calcification within the pulmonary lesion, as shown in one of our cases, is also rare (14,15,17,18). Surrounding groundglass opacity or the CT halo sign, as found in our study, and isolated groundglass opacity (6,(8)(9)(10)(11)17) can be observed. Although centrilobular or satellite nodules have been described (6,8), tree-inbud appearance was observed neither in the present nor in previous studies (6)(7)(8)(9).…”

Section: Discussionsupporting

confidence: 76%

“…Cavitation and air-filled bronchograms within nodules or consolidation, observed in 58.3% of our cases, have been variably demonstrated in previous studies, ranging from 0% to 42% of cases (4)(5)(6)(7)(8)(9)(10)(11)15). Nonenhanced, low-attenuation areas within the areas of consolidation or masses, previously shown to represent gelatinous collections of large numbers of fungal organisms or rarely ischemic necrosis (12,15,16) were also frequently demonstrated on CT images in our study but have rarely been described (17).…”

Section: Discussionsupporting

confidence: 61%

“…According to previous studies from many countries in North America, Europe, and the East (3)(4)(5)(6)(7)(8)(9)(10)(11), most immunocompetent individuals have mild or no clinical symptoms with isolated pulmonary involvement through single or multiple small pulmonary nodules. These findings are somewhat different from the more aggressive clinical and radiographic findings described in isolated case reports among Thai immunocompetent patients (6,(12)(13)(14) and in a study from South America (3). Therefore, there might be potential differences in the clinical and radiologic characteristics of pulmonary cryptococcosis among different geographic regions and hospital settings.…”

Section: P Ulmonary Cryptococcosis Is An Emerging Infection Caused Bymentioning

confidence: 99%

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Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. MATERIALS AND METHODSWe retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012. RESULTSTwelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6). CONCLUSIONPulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 61%

Section: P Ulmonary Cryptococcosis Is An Emerging Infection Caused Bymentioning

confidence: 99%

See 2 more Smart Citations

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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show abstract

“…The clinical expression is variable and may present as coughing, expectoration, chest tightness, fever or asymptomatic. The most common radiological characteristics are known to be solitary or multiple pulmonary nodules, and segmental or lobar consolidation (10,11). For these reasons, pulmonary cryptococcosis is frequently misdiagnosed as other lung diseases, such as cancer and pneumonia.…”

Section: Plain and Contrast-enhanced Chest Computed Tomography Scan Fmentioning

confidence: 99%

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

et al. 2017

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Abstract. Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92±5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61±8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.

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Steroid resistance in organizing pneumonia caused by pulmonary cryptococcosis

Nomura

Ohta

Hiruta

et al. 2020

Respirology Case Reports

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Cryptogenic organizing pneumonia (COP) usually responds well to steroid therapy; however, recurrence is commonly observed when the steroid dose is tapered. A 74-year-old man suspected of having steroid-resistant COP presented to our hospital. Chest computed tomography (CT) revealed new consolidations of the left inferior lobe despite administration of a moderate dose of oral steroids. Repeated transbronchial lung biopsy showed pulmonary cryptococcosis. The left interior consolidations shrank gradually after antifungal therapy was initiated. Immunocompromised patients with pulmonary cryptococcosis show various CT findings, and consolidation is frequently observed. Superimposed pulmonary cryptococcosis infection should be considered in cases of steroid-refractory COP.

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Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings in 12 Patients

Cited by 87 publications

References 27 publications

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

Steroid resistance in organizing pneumonia caused by pulmonary cryptococcosis

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