A fatal case of pulmonary cryptococcosis in an apparently immunocompetent patient from Cote D' Ivoire

Abstract

Cryptococcosis is an opportunistic mycosis caused by Cryptococcus, mainly affecting the immunocompromised. We report a case of pulmonary cryptococcosis within a 31-year-old immunocompetent patient admitted for painful chest swelling evolving for 4 months prior to admission. The chest X-Ray showed a rounded pulmonary opacity. The chest ultrasound revealed a pulmonary abscess diffusing under the skin. Direct examination using the Indian ink and the May-Grunwald Giemsa staining revealed encapsulated yeasts in the pus. The Culture of the pus on the Sabouraud medium with chloramphenicol confirmed the presence of Cryptococcus neoformans. Cryptococcal antigen was positive. This case reminds us that cryptococcosis should be considered even without immunosuppression.

Keywords: Cote d’Ivoire; Cryptococcosis; Cryptococcus neoformans; Immunocompetent; Lung.

Fig. 1

A clinical feature of cryptococcosis pulmonary: a large swelling in the left hemithorax of a young male.

Fig. 2A

Radiological aspects: Voluminous and homogeneous opacity occupying the lower 2/3 of the left pulmonary hemichamber, raising the suspicion of a pulmonary tumor or cyst on radiography.

Fig. 2B

Voluminous left pulmonary hyperdensity on thoracic CT scan.

Fig. 3

(MGG, 40 X). Yeasts measuring 4–8 μm in diameter surrounded by a clear halo.

Fig. 4

Culture (Sabouraud medium enriched in chloramphenicol): the growth of yeasts within 48 hours at 37 °C.