Pulmonary Cryptococcosis

Abstract

It is becoming increasingly evident that Cryptococcus infections must be considered in the differential diagnosis of certain types of pulmonary lesions. The causative organism Cryptococcus neoformans (Torula histolytica) is a single budding fungus of world-wide distribution. It can be distinguished from non-pathogenic Cryptococci occurring in the oropharynx by certain cultural methods and by tissue invasion on animal inoculation. In a review of the English literature on cryptococcosis, it was found that at least 75 cases in which the lungs were affected were recorded prior to 1953. Seven additional cases are presented here, bringing the total to 82. This number is approximately one-third of the total of more than 250 cases of cryptococcal infection reported. It is probable that the lung is involved more often than these figures indicate, since it is believed that the causative organism gains access to the body through the respiratory tract. The infection may remain localized there or may spread to adjacent lymph nodes or other organs. The initial pulmonary lesion may heal with or without dissemination of the disease. Case Reports Case I: E. H., a 28-year-old colored male, complained of headaches, experienced over a period of six months, and gradually developing drowsiness. Three days before admission to Lawson Veterans Administration Hospital, he had a generalized clonic convulsion followed by stupor. On admission he was comatose, his neck was stiff, and his reflexes were increased. Roentgenograms showed multiple small, rounded, nodular densities throughout both lung fields (Fig. 1). Death occurred about ten weeks later. A postmortem examination revealed Cryptococcus meningitis with dissemination of miliary granulomata throughout the lungs, liver, and spleen. Case II: B. S. F., a 58-year-old white female, was admitted to Georgia Baptist Hospital in a stuporous condition in May 1949. Kernig and Brudzinski's signs were positive. The liver and spleen were enlarged. Cryptococci were identified in the spinal fluid in an India ink preparation. Roentgenograms of the chest disclosed linear infiltrations and small nodulations throughout the right lung and similar infiltrates with large confluent areas of consolidation in the left lung (Fig. 2). Similar but less extensive infiltrates had been present since 1947, when the patient had been observed in a tuberculosis sanitarium. At that time, numerous smears, cultures, and animal inoculations of the sputum failed to reveal acid-fast bacilli. During the present admission, tuberculin, blastomycin, coccidioidin, and histoplasmin skin tests were negative. The patient's condition improved while she was hospitalized, but she died later at home. Permission for postmortem examination was not obtained.