Gao Cheng-Yan, Yang Xue-Jiao, Guo E, Zheng Yu-Lan
School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China.
Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei Province, China.
World J Clin Cases. 2025 Jul 16;13(20):105133. doi: 10.12998/wjcc.v13.i20.105133.
Worldwide, there has been a steady increase in the number of cases of pulmonary cryptococcosis diagnosed in immunocompetent patients, where symptoms can range from mild to severe. Clinical and radiological distinction of disease may be made when compared with immunodeficient cases and in those presenting with primary lung carcinoma. In the latter case confusion can lead to initial misdiagnosis and delayed treatment. We report a case of disseminated cryptococcosis in an immunocompetent patient which mimicked a primary lung carcinoma with brain metastases.
A 51-year-old male farmer with a 30-year smoking history presented with a two-week history of productive cough, streaky hemoptysis, and low-grade fever. He had no history of immunosuppression, tuberculosis, or specific risk factors. Chest computed tomography revealed a posterior basal left lower lobe mass, but tumor markers and transbronchial tests were negative. Brain magnetic resonance imaging showed an enhancing left frontal lobe lesion, raising suspicion for metastatic lung cancer. However, computed tomography-guided biopsy confirmed fungal pneumonia with "titan" cells, and a positive serum cryptococcal antigen test confirmed infection. Bronchoscopy and lavage detected fungal spores, while cerebrospinal fluid cytology and culture were negative. Fluconazole (0.4 mg/day) was initiated, but progressive central nervous system lesions required amphotericin B. A six-week combination of fluconazole (600 mg/day) and flucytosine led to resolution. At 24-month follow-up, he remained asymptomatic with no recurrence.
Cryptococcosis is increasing in immunocompetent individuals in China and should be considered in pneumonia and lung or brain lesions.
在全球范围内，免疫功能正常患者中诊断出的肺隐球菌病病例数量一直在稳步增加，其症状可轻可重。与免疫缺陷病例以及原发性肺癌患者相比，该病在临床和影像学上可能存在差异。在后一种情况下，混淆可能导致最初的误诊和治疗延误。我们报告一例免疫功能正常患者的播散性隐球菌病，其表现类似于伴有脑转移的原发性肺癌。
一名51岁男性农民，有30年吸烟史，出现咳嗽咳痰、痰中带血丝和低热两周。他没有免疫抑制、结核病或特定危险因素的病史。胸部计算机断层扫描显示左肺下叶后基底段有一肿块，但肿瘤标志物和经支气管检查均为阴性。脑部磁共振成像显示左侧额叶有强化病变，怀疑为转移性肺癌。然而，计算机断层扫描引导下的活检证实为伴有“巨细胞”的真菌性肺炎，血清隐球菌抗原检测呈阳性证实感染。支气管镜检查和灌洗检测到真菌孢子，而脑脊液细胞学检查和培养均为阴性。开始使用氟康唑（0.4毫克/天），但进行性中枢神经系统病变需要使用两性霉素B。氟康唑（600毫克/天）和氟胞嘧啶联合使用六周后病情缓解。在24个月的随访中，他无症状，无复发。
中国免疫功能正常个体中隐球菌病的发病率在上升，在肺炎及肺部或脑部病变中应考虑该病。
