Cryptogenic Cryptococcus: A Case of Pulmonary Cryptococcosis Masquerading as Lung Cancer in an Immunocompetent Patient

Abstract

Cryptococcal pulmonary nodule in an immunocompetent individual is rare. Here, we perform a literature review on management of asymptomatic pulmonary cryptococcus detected incidentally on radiological imaging. CASE PRESENTATION: An 80-year-old African American male with past medical history of stage II prostate cancer and hypertension presented to our hospital with subacute onset of bilateral lower limb weakness. Extensive workup was inconclusive for etiological diagnosis but showed an incidental 1.2 x 0.9 cm spiculated left upper lobe nodular density on CT chest. Biopsy of the lesion was performed to determine cause and to rule out paraneoplastic syndrome. Cytology was negative for malignant cells but, in fact showed localized granulomatous reaction with fungal forms consistent with Cryptococcus. Serum and CSF were negative for Cryptococcal antigen. He was HIV negative and had no respiratory symptoms. Treatment with fluconazole 400 mg once a day was initiated.