Diagnostic and Interventional Radiology
Chest Imaging - Original Article

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

1.

Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

2.

Department of Radiology Thailand; Banmi Hospital , Lopburi Province, Thailand.

3.

Department of Pulmonary and Critical Care Medicine Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand

4.

Department of Infectious Diseases; Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand

5.

Department of Pathology Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand

Diagn Interv Radiol 2013; 19: 438-446
DOI: 10.5152/dir.2013.13049
Read: 588 Downloads: 426 Published: 03 September 2019

Abstract

PURPOSE:
We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment.


MATERIALS AND METHODS:
We 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.

RESULTS:
Twelve 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).

CONCLUSION:
Pulmonary 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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