Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe

Abstract

Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis.

CT Signs and Differential Diagnosis of Peripheral Lung Cancer and Inflammatory Pseudotumor: A Meta-Analysis

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“…Differential diagnosis is essential for the adoption of adequate practices 6 ; in particular, the distinction between benign and malignant lesions is important because the treatment and prognosis of these two disease groups are distinct 8 . However, lung cancer high incidence and lethality can influence medical decisions and sometimes erroneously direct the diagnostic process to the search for malignant lesions 5 , 9 , without including routine tests to diagnose other diseases. Thus, the diagnosis of a potential benign disease is delayed, which negatively affects its progression, increases hospital costs, and exposes patients to unnecessary risks 7 .…”

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“…Therefore, beyond being the only system register and approved by the ANVISA for this purpose, now has the certificate and the seal of the FDA (FDA, 2001 The Vitek  2 Compact system is a practical and efficient tool used widely by researches for microbial identification (Melhen et al, 2014;Pereira, 2010;Silva et al, 2013;Zhang et al, 2014).…”