A RARE CASE OF CRYPTOCOCCUS NEOFORMANS BY PLEURAL BIOPSY

Abstract

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Cryptococcus are an opportunist fungal pathogen that can lead to life threatening infections usually in immunocompromised individuals, however it is rare in those who are immunocompotent. This case report presents a patient who came in with non-specific symptoms and generalized lymphadenopathy with a diagnosis of cryptococcus with pleuroscopy. CASE PRESENTATION: A 47 year old female with a past medical history of hypothyroidism and previous COVID 19 infection presents with weight loss, generalized lymphadenopathy and shortness of breath to a tertiary care center. Initial work up including chest imaging showed a right sided pleural effusion. Further imaging via computed tomography of the chest showed a free flowing moderate to large pleural effusion and right sided pleural thickening. This effusion was drained without complication, which showed an exudative etiology. Cultures and cytology from the pleural fluid showed were non diagnostic. Although the patient had a comprehensive infectious work up, and biopsy of a lymph node, both were non diagnostic for an infectious or malignant etiology. A pleuroscopy was performed, which showed multiple white deposits along the inferior portion of the right lung and the diaphragm, which were biopsied. These biopsies grew cryptococcus neoformans, with further history correlating with cave exploration and exposure to endemic fungi. DISCUSSION: Cryptococcus grows readily in soil contaminated with bird excretions, and is transmitted via inhalation of the contaminated aerosol. Here, we presented a rare case of Cryptococcal infection diagnosed via pleuroscopy and pleural biopsy. The patient had blood cultures, respiratory cultures, gram stain, along with culture data from pleural fluid which showed no growth. Furthermore, the patient also had testing via Cryptococcal antigen, which was negative. The patient had no known immunodeficiency condition such as HIV, diabetes, renal failure, liver failure, use of steroids, or other immunosuppressive drugs. Furthermore, the patient had excisional lymph node biopsies which ruled out malignancy. The aim of this report is to utilize pleuroscopy and pleural biopsy in those patients with a high likelihood of an infectious etiology with pleural disease. CONCLUSIONS: Cryptococcal meningitis should be a diagnostic consideration even when dealing with meningitis in immunocompetent patients. Cryptococcal antigen test can help us clinch the diagnosis in time though culture would be a better diagnostic tool if available. However, in the setting of this test being negative, and other non diagnostic infectious work up, biopsy of the pleura involved can aid in the diagnosis of a fungal infection if the likelihood is high. REFERENCE #1: Curi AL, Lazera M, Vasconcelos-Santos DV: Cryptococcosis. In Intraocular Inflammation.Springer, Berlin, Heidelberg.2016;1277–1283. 10.1007/978-3-540-75387-2_123 DISCLOSURES: No relevant relationships by Selvin Jacob, source=Web Response No relevant relationships by Pushan Jani, source=Web Response