Zhao ZhiPeng, Liu Chong, Yang JianZhu, Ren GuangWei, Zhang LiHong, Wang Tao
Graduate School of HeBei Medical University, Shijiazhuang 050011, China.
Department of Medical Imaging, the First Hospital of HeBei Medical University, ShiJiaZhuang 050030, China.
IDCases. 2023 Oct 13;34:e01916. doi: 10.1016/j.idcr.2023.e01916. eCollection 2023.
In patients with membranous nephropathy (MN), malignancy may be either the underlying disease or results of immunosuppressive therapy which may also lead to opportunistic infections including the pulmonary cryptococcosis. On CT scan, nodule is the most common feature in pulmonary cryptococcosis and it can mimic lung cancer both clinically and radiologically. Therefore, pulmonary nodular lesions caused by cryptococcosis may be easily misdiagnosed and require unnecessary surgical treatment. As such, we herein presented an isolated subpleural solitary nodule with satellite lesion that closely mimicked lung cancer on both contrast-enhanced computed tomography (CT) scan and F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT in an MN patient under long-term tacrolimus regimen. Cryptococcosis was ascertained by the finding of oval thick-walled yeast on histopathology of the lung biopsy specimen taken during the Argon-Helium cryotherapy. Further, the pulmonary lesions progressively dissipated after antifungal treatment. Arguably, our experience may help clinicians in general and nephrologists in particular with a better understanding of the cryptococcal infection manifesting as pulmonary nodule(s) in the MN patients and contribute to more efficacious differential diagnosis against the lung cancer.
在膜性肾病（MN）患者中，恶性肿瘤可能是潜在疾病，也可能是免疫抑制治疗的结果，免疫抑制治疗还可能导致包括肺隐球菌病在内的机会性感染。在CT扫描中，结节是肺隐球菌病最常见的特征，在临床和放射学上都可能与肺癌相似。因此，由隐球菌病引起的肺结节性病变可能很容易被误诊，并需要进行不必要的手术治疗。在此，我们报告了1例长期接受他克莫司治疗的MN患者，其在对比增强计算机断层扫描（CT）和F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）/CT上表现为一个伴有卫星灶的孤立性胸膜下实性结节，酷似肺癌。通过在氩氦冷冻治疗期间获取的肺活检标本的组织病理学检查发现椭圆形厚壁酵母，确诊为隐球菌病。此外，抗真菌治疗后肺部病变逐渐消散。可以说，我们的经验可能有助于普通临床医生，尤其是肾病学家更好地理解MN患者中表现为肺结节的隐球菌感染，并有助于更有效地鉴别诊断肺癌。
