It Ain't Called Crypto for Nothing

Abstract

SESSION TITLE: Fungal Infections 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: In the age of Chest CTs, pulmonary nodules are a common finding and determining the etiology and need for treatment can be challenging. The differential for pulmonary nodules includes infection, rheumatologic manifestations, malignancy, and inflammatory lung diseases. In the work up of these findings, patient characteristics, risk factors, and clinical history help to narrow the potential causes. However, in medicine, things are often not as simple, and a simplistic approach to pulmonary nodules may lead to missed diagnoses. In this case series, we present two cases of biopsy-proven Cryptococcal pneumonia in immune competent pts. CASE PRESENTATION: In both cases, our patients were M in their 60s, without any known immune dysfunction, malignancy, HIV, or history of chronic steroid use. The first patient (pt A) presented to the ED, with c/o SOB, chest pain, subacute dry cough, and fatigue. CTA of the chest was performed which revealed multiple large pulmonary nodules and adenopathy. The second patient (pt B) presented for a second opinion given progressive SOB, fatigue, and weight loss with pulmonary nodules refractory to antibiotic therapy. In both cases, an infectious work-up was completed and included fungal testing and rheumatologic screening which were all negative. PET CTs were obtained and in both cases the lesions were highly PET avid. Biospies were subsequently performed (Pt A CT guided biopsy, Pt B VATs wedge biopsy) and revealed Crytoccoccus neoformans. Pts LPs' were negative for CNS involvement. Both pts were started on Fluconazole with clinical and radiographic improvement. DISCUSSION: Cryptococcal pneumonia is a relatively rare diagnosis, even more rare in immune competent patients. Findings on chest imaging often include nodular opacities with or without cavitation, adenopathy, and pleural effusions. These findings however, are non-specific and are associated with multiple disease states. Despite a low pre-test probability, biopsy-proven Cryptococcal pneumonia was identified and subsequently treated in these immune competent patients. CONCLUSIONS: Although a rare entity in immune competent hosts, Cryptococcal pneumonia should remain on the differential in the work-up of pulmonary nodules in the immune competent host. Reference #1: Cryptococcal pneumonia: the great mimicker, Lasya Thambidurai MD, et al. British Journal of Radiology. Published Online: January 05, 2017 Reference #2: Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology 2005; 236: 326-31 DISCLOSURE: The following authors have nothing to disclose: Amit Bharara, Rebecca Potfay, George Kallingal No Product/Research Disclosure Information