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

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.

• Authors: Thitiporn Suwatanapongched, Wasinan Sangsatra, Viboon Boonsarngsuk, Siriorn P Watcharananan, Pimpin Incharoen
• Journal: Diagnostic and interventional radiology (Ankara, Turkey) (Diagn Interv Radiol) 2013 Nov-Dec Vol. 19 Issue 6 Pg. 438-46 ISSN: 1305-3612 [Electronic] Turkey
• PMID: 23864332 (Publication Type: Journal Article)

Chemical References

• Antifungal Agents

Topics

• Adult
• Airway Obstruction (diagnostic imaging, etiology)
• Antifungal Agents (therapeutic use)
• Bronchiectasis (diagnostic imaging, etiology)
• Calcinosis (diagnostic imaging, etiology)
• Cryptococcosis (complications, diagnostic imaging, drug therapy)
• Female
• Humans
• Immunocompetence
• Lung Diseases, Fungal (complications, diagnostic imaging, drug therapy)
• Lymphatic Diseases (diagnostic imaging, etiology)
• Male
• Middle Aged
• Pulmonary Fibrosis (diagnostic imaging, etiology)
• Retrospective Studies
• Tomography, X-Ray Computed
• Young Adult