Cryptococcus gattii Infection Presenting as an Aggressive Lung Mass
Cryptococcus gattii is an endemic fungus predominantly isolated in the tropical and subtropical regions, causing predominantly pulmonary disease with a predilection for the central nervous system. Herein, we report a case of rapidly progressing C. gattii pneumonia in an immune-deficient but virologically suppressed host with underlying human immunodeficiency viral (HIV) infection, exhibiting various fungal morphologies from bronchoalveolar lavage (BAL) cytological specimens. A 51-year-old Chinese male with known HIV disease was admitted to the Singapore General Hospital for evaluation of functional decline, febrile episodes, and a left hilar mass on chest radiograph. Computed tomography (CT) showed consolidation in the apical segment of the left lower lobe. He underwent bronchoscopy and BAL. Positron emission tomography-computed tomography done 10 days after the initial CT showed approximate doubling of the pulmonary lesion. Cytological examination of the fluid revealed yeasts of varying sizes. Subsequent fungal culture from BAL fluid grew C. gattii 10 days later.
KeywordsCryptococcus gattii pneumonia Cryptococcosis Rapidly enlarging lung mass Aggressive lung mass Human immunodeficiency virus infection
We would like to thank Dr. Ong Tan Ching from the Research Office of Nanyang Technological University for helping us with the identification of pollen grains and fungal spores. We would also like to thank Dr. Tan Ai Ling, Ms. Tan Mei Gie, and Ms. Delphine Cao from the Department of Microbiology, Singapore General Hospital, for assisting us in the MLST analysis of the C. gattii isolate. Last but not least, we are grateful to the Medical Publication Support Unit, National University Health System, for their publication support.
- 3.Chen SC-A, Slavin MA, Health CH, Playford EG, Byth K, Marriott D, Kidd SE, Bak N, Currie B, Hajkowicz K, Korman TM, McBride WJ, Meyer W, Murray R, Sorrell TC. Clinical manifestations of Cryptococcus gattii infection: determinants of neurological sequelae and death. Clin Infect Dis. 2012;55:789–98.CrossRefPubMedGoogle Scholar
- 5.Chong KY, Tan HTW, Corlett RT. A checklist of the total vascular plant flora of Singapore. Native, naturalized and cultivated species. Raffles Museum of Biodiversity Research, National University of Singapore 2009.Google Scholar
- 9.Ho SW, Ang CL, Ding CS, Barkham T, Teoh LC. Necrotizing fasciitis caused by Cryptococcus gattii. Am J Orthop (Belle Mead NJ). 2015;44(12):E517–22.Google Scholar
- 16.Chen S, Sorrell T, Nimmo G, Speed B, Currie B, Ellis D, Marriott D, Pfeiffer T, Parr D, Byth K. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group. Clin Infect Dis. 2000;31(2):499–508.CrossRefPubMedGoogle Scholar
- 17.Tseng HK, Liu CP, Ho MW, Lu PL, Ho HJ, Lin YH, Cho WL, Chen YV. Taiwanese Infectious Diseases Study Network for Cryptococcosis. Microbiological, epidemiological, and clinical characteristics and outcomes of patients with cryptococcosis in Taiwan, 1997–2010. PLoS ONE. 2013;8(4):e61921.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Purushotham MK, Chinaiah C, Lingaiha HM. Primary pulmonary cryptococcosis in an immunocompetent patient. Clin Cancer Investig J. 2015;4:365–7.Google Scholar
- 28.Harris JR, Lockhart SR, Sondermeyer G, Vugia DJ, Crist MB, D’Angelo MT, Sellers B, Franco-Paredes C, Makvandi M, Smelser C, Greene J, Stanek D, Signs K, Nett RJ, Chiller T, Park BJ. Cryptococcus gattii infections in multiple states outside the US Pacific Northwest. Emerg Infect Dis. 2013;19(10):1620–6.CrossRefPubMedGoogle Scholar