Pulmonary cryptococcosis with headache as the first presentation: A case report

Abstract

Pulmonary cryptococcosis (PC) is an invasive fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. Its clinical presentation and radiological findings are often non-specific, making early diagnosis challenging. Herein, the case of a 44-year-old male who presented with dizziness and headache is reported. Initial cranial magnetic resonance imaging and chest computed tomography (plain and contrast-enhanced) suggested lung cancer with brain metastasis. A definitive diagnosis was established only after a lung mass biopsy, followed by a cytological smear and histopathological analysis, confirmed PC. The patient was treated with antifungal therapy postoperatively and responded well. This case underscores the importance of considering PC in differential diagnoses to enable prompt diagnosis and treatment, potentially reducing associated mortality.

Keywords: Cryptococcus; cytology; diagnosis; differential diagnosis; initial symptom.

Figure 1

Head MRI showing irregular cystic nodules in the left cerebellum with ring enhancement on enhanced scan, and spectral spectroscopy (MRS) suggested that the lesions were mainly necrotic: (a) Enhancement and (b) MRS.

Figure 2

Chest CT: A mass shadow is found in the lower lobe of the right lung, with clear boundaries and uneven density, and patchy low-density shadow is found within it. (a) Plain scan and (b) enhanced arterial phase.

Figure 3

Spheroidal thellites of varying sizes were observed in traditional cytological smears, The cells were purplish red and without nuclei. Cytological Pap staining: (a) ×100 and (b) ×400.

Figure 4

Under the microscope of histopathological biopsy, Cryptococcus are seen in the foamy cells and extracellular stroma, which are round or oval, slightly blue-stained or vacuolated, varying in size and surrounded by a transparent and refractive capsule. H&E (a) ×200 and (b) ×400.

Figure 5

Cryptococcus can stain the fungal walls in GMS (a) and PAS (b) as purplish red and brown-black, respectively. ×400.

Figure 6

Head MRI after 1 week of antifungal therapy: Irregular ring-enhanced nodules in the left cerebellar hemisphere with surrounding patchy cerebral oedema. The lesions in the left cerebellar hemisphere are smaller than before, and the enhancement ring is thicker and more obvious than before. (a) Enhancement and (b) MRS.