SHM Converge Scientific Abstract ePoster Gallery-The Great Mimicker: a Tale of a Cryptic Pneumonia

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This case describes a 53-year-old immunocompetent woman who was incidentally found to have multiple right lower lobe lung masses, the largest measuring 6.5 × 2.4 cm. Because the imaging appearance raised concern for malignancy, she underwent a CT-guided lung biopsy.<br /><br />Pathology showed no cancer. Instead, it revealed necrotizing granulomas containing numerous fungal organisms that stained positive with Grocott Methenamine Silver (GMS) and Mucicarmine, findings consistent with cryptococcal infection. Laboratory testing supported this diagnosis, with a cryptococcal antigen titer of 1:32. She had no HIV and a high CD4 count, confirming that she was not immunocompromised. Testing for other fungal infections, including Histoplasma, Blastomyces, Candida, Coccidioides, and Aspergillus, was negative. A review of exposure risks, such as travel to endemic regions, spelunking, and pigeon exposure, was also unrevealing.<br /><br />The patient was discharged on fluconazole with outpatient infectious disease follow-up and plans for repeat imaging to assess response.<br /><br />The discussion emphasizes that pulmonary cryptococcosis is classically associated with immunocompromised patients, but it can also occur in immunocompetent individuals and mimic lung cancer on imaging. Because cryptococcal lung masses can resemble tumors, clinicians should keep a broad differential when evaluating pulmonary masses. According to IDSA guidelines, fluconazole is the recommended treatment for 6–12 months, with duration guided by clinical and radiographic response. In this setting, treatment is important not only for cure but also to reduce the risk of systemic dissemination.

Asset Subtitle

Taimur Bayar-Masood

Meta Tag

Author List Lawrence Ward, Mohammed O. Choudary, Taimur Bayar-Masood

Category Clinical Vignettes

Concept Isolated Pulmonary Cryptococcosis

Concept Cryptococcal Pneumonia

Concept Fluconazole

Concept Asymptomatic Lung Mass

Concept Immunocompetent Patient

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Taimur Bayar-Masood

Track Adult

Keywords

pulmonary cryptococcosis

immunocompetent

lung masses

cryptococcal infection

necrotizing granulomas

Grocott Methenamine Silver

Mucicarmine stain

fluconazole

lung biopsy

malignancy mimic

Isolated Pulmonary Cryptococcosis

Cryptococcal Pneumonia

Fluconazole

Asymptomatic Lung Mass

Immunocompetent Patient