SHM Converge Scientific Abstract ePoster Gallery-A "Cryptic" Cause of a Lung Mass in an Immunocompetent Patient

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An 86-year-old immunocompetent woman with COPD and prior pulmonary infections presented with cough-related abdominal pain, and CT imaging revealed a new 2 cm irregular right upper lobe subpleural lung nodule. Initial transbronchial biopsy, bronchoalveolar lavage, AFB studies, and fungal serologies were negative, but PET-CT showed increased uptake and the mass remained stable on repeat imaging. A subsequent CT-guided biopsy finally identified <strong>Cryptococcus</strong> on histopathology. 

Before treatment could begin, the patient returned with worsening cough, dyspnea, low-grade fever, tachypnea, and increased hypoxia. Serum cryptococcal antigen was positive at a low titer (1:20), HIV testing was negative, and she had not used systemic steroids recently. She was started on fluconazole for presumed cryptococcal pneumonia, with a plan for 6 to 12 months of therapy. Infectious disease specialists advised against lumbar puncture because she had no CNS symptoms, was not immunocompromised, and had a low cryptococcal antigen titer. Her hospital course was prolonged by dyspnea, and she was discharged on hospital day 18.

This case highlights that <strong>Cryptococcus can cause pulmonary disease even in apparently immunocompetent patients</strong> and may present as a lung nodule or mass that mimics malignancy. It also emphasizes the importance of distinguishing mild-to-moderate pulmonary cryptococcosis, which may be treated with oral fluconazole, from severe disease with CNS or disseminated involvement, which requires more aggressive management.

Asset Subtitle

Ashmita Siwakoti

Meta Tag

Author List Ashmita Siwakoti, Hirotaka Kato

Category Clinical Vignettes

Concept Cryptococcal Pneumonia

Concept Fluconazole

Concept Lung Mass

Concept Pulmonary Nodules

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Ashmita Siwakoti

Track Adult

Keywords

Cryptococcus

pulmonary cryptococcosis

lung nodule

immunocompetent

fluconazole

cryptococcal pneumonia

right upper lobe

PET-CT

biopsy

fungal infection

Cryptococcal Pneumonia

Fluconazole

Lung Mass

Pulmonary Nodules

Biopsy