Cryptococcus gattii fungemia: report of a case with lung and brain lesions mimicking radiological features of malignancy

Abstract

SUMMARYA 64-year-old apparently immunocompetent white man developed lung and brain lesions of disseminated cryptococcosis. The radiologic features mimicked those of lung cancer metastatic to the central nervous system. C. gattii was recovered from cultures of bronchoalveolar lavage fluid, brain biopsy, and blood. The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C. neoformans.

Cryptococcus gattii: a resurgent fungal pathogen

“…Similar to other ‘primary pathogenic fungi’, C. gattii causes disseminated skin and lung lesions that can potentially be misdiagnosed as malignancies 31-33 . Brain infections (meningoencephalitis) caused by C. gattii are reported to respond slowly to standardized therapy, and they require more diagnostic follow-ups than those seen in C. neoformans infections 34-37 .…”

Capítulo 3: criptococose pulmonar

“…(42,43) Numerous spherical microorganisms or oval microorganisms (or a combination of the two) of 2-20 µm in diameter, surrounded by a light halo and arranged extracellularly, are Isolated pulmonary cryptococcosis (without brain metastasis) or pulmonary cryptococcosis accompanied by brain mass (with brain metastasis) caused by C. gattii can mimic lung cancer clinically and radiologically (Figures 2 and 3). (37) Cases of upper lobe consolidation with atypical presentation of Pancoast syndrome have been described. (38) Pulmonary manifestations are more common than CNS manifestations in immunocompromised patients with cryptococcosis.…”

Capítulo 1: diagnóstico laboratorial das micoses pulmonares

“…For the isolation of yeast (genera Candida, Trichosporon and Cryptococcus), these methods are equivalent; however, the lysis-centrifugation blood culture system is considered the gold standard for the isolation of thermally dimorphic fungi, especially H. capsulatum, in blood samples. (4,(14)(15)(16)(17)(18) In the lysis-centrifugation blood culture system, the blood obtained by means of sterile venous puncture should be inoculated into a specific vial, containing sodium polyanethol sulfonate, polypropylene glycol and saponin, and then homogenized and centrifuged (5,100 rpm). Subsequently, the sediment obtained should be seeded onto two culture media (Sabouraud agar at 25°C and brain-heart infusion agar at 35°C) and cultured for up to three weeks.…”