Cryptococcus pneumonia presenting in an immunocompetent host with pulmonary asbestosis: a case report

Our plain-English summary of Cryptococcus pneumonia presenting in an immunocompetent host with pulmonary asbestosis: a case report, by J.P. Guy, S. Raza, E. Bondi, et al (Journal of Medical Case Reports, 2012).

The study

• Authors: J.P. Guy, S. Raza, E. Bondi, Y. Rosen, D.S. Kim, B.J. Berger
• Journal: Journal of Medical Case Reports
• Published: 2012;6:170
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Cryptococcal infections pose a diagnostic challenge in an immunocompetent host. Asbestos exposure has been associated with pulmonary aspergillosis. This case highlights an interesting presentation of cryptococcal lung inflammation with underlying asbestosis.

Case Presentation: A 63-year-old Mediterranean Caucasian woman presented with progressive dry cough of nine months duration. A computed tomography (CT) scan of her chest revealed multiple foci in the right infra-hilar region, which were seen as hot lung masses on a positron emission tomography (PET) scan. These multiple foci appeared metastatic in nature throughout both lung fields with early mediastinal invasion. A computed tomography (CT)-guided core biopsy was obtained from a dominant right lower lobe lung mass. Histology showed chronic granulomatous inflammation with numerous budding yeast forms that were GMS-, PAS-, and mucin-positive, consistent with cryptococcosis together with asbestos bodies (ferruginous). She was managed with fluconazole (400mg (6mg/kg) per day orally) daily. At her six-month follow up, she had marked improvement in her general condition along with a diminution of the lower lobe lung mass.

Conclusion: We report a clinical and radiological improvement in a patient treated for cryptococcal pneumonia. Asbestos exposure was likely to have been an important pathophysiological precursor to infection by environmental fungi.

In plain English

This case report described one 63-year-old Mediterranean Caucasian woman born in Turkey. She had mild shortness of breath on exertion and a dry cough that had worsened over nine months. She had been exposed to asbestos through building materials commonly used in eastern Turkey; no fiber type is named. After moving to New York she had been treated for pulmonary tuberculosis, and she had never smoked. Scans showed multiple lung masses that looked like spreading cancer. A needle biopsy of a dominant right lower lobe mass showed chronic inflammation with budding yeast consistent with cryptococcosis, a fungal infection. It also showed ferruginous bodies consistent with asbestos bodies. Cultures, a blood test for cryptococcal antigen, and an HIV test were negative. She took the antifungal drug fluconazole, 400 mg a day by mouth, for four months, and her symptoms and chest X-ray improved. The authors concluded that biopsy was needed to rule out cancer, and that her asbestos exposure was likely a precursor to both her tuberculosis and her fungal infection. A single case does not show how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 63-year-old Mediterranean Caucasian woman, born in Turkey, who immigrated to the United States at age 37 and was seen in New York; previously treated for pulmonary tuberculosis; never smoked
• Exposure: Asbestos exposure through building materials commonly used in eastern Turkey; fiber type not specified
• Main results:
  • Imaging showed multiple FDG-PET positive lung masses and CT findings throughout both lung fields with early mediastinal invasion, appearing metastatic
  • Biopsy of a dominant right lower lobe mass showed chronic granulomatous inflammation with numerous budding yeast forms consistent with cryptococcosis
  • Ferruginous bodies consistent with asbestos bodies were present in the biopsy
  • Cultures of the specimen for acid fast bacilli, fungi and bacteria were negative
  • Serum cryptococcal antigen and HIV ELISA tests were negative
  • She was treated with fluconazole 400 mg (6 mg/kg) per day orally for four months; at four-month follow-up her symptoms had markedly improved and a chest radiograph showed significant reduction of the basilar infiltrates
• The authors' conclusion: The authors concluded that biopsy was essential to exclude malignancy, that the ferruginous bodies confirmed the radiographic appearance of asbestosis, and that asbestos exposure was likely a precursor to both her tuberculosis and her susceptibility to infection by environmental fungi

Topics

Medical terms in this study, explained in our Lexicon: Asbestosis, Asbestos Exposure, Inflammation, Biopsy, Histology, Asbestos Bodies.

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