Li XN, Chen JH, Lu ZW. Pulmonary cryptococcosis in immunocompetent children presenting with chest pain: Three case reports. World J Clin Cases 2025; 13(16): 100672 [DOI: 10.12998/wjcc.v13.i16.100672]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Pulmonary cryptococcosis in immunocompetent children presenting with chest pain: Three case reports
Xiao-Nan Li, Jie-Hua Chen, Zhi-Wei Lu
Xiao-Nan Li, Zhi-Wei Lu, Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong Province, China
Jie-Hua Chen, Department of Respiratory, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong Province, China
Author contributions: Li XN contributed to manuscript writing and data collection; Chen JH contributed to manuscript review and editing; Lu ZW contributed to data analysis, manuscript review and editing; all authors have read and approved the final manuscript.
Supported by Shenzhen Fund for Guangdong Provincial High-Level Clinical Key Specialties, No. SZGSP012; and Shenzhen Key Medical Discipline Construction Fund, No. SZXK032.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patients’ parents/guardians agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist statement, and the manuscript was prepared and revised according to the CARE Checklist statement.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: August 22, 2024 Revised: December 11, 2024 Accepted: January 17, 2025 Published online: June 6, 2025 Processing time: 171 Days and 16.9 Hours
Abstract
BACKGROUND
Cryptococcus is a systemic opportunistic pathogenic fungus that can cause infections in both immunocompromised and immunocompetent hosts, with diverse clinical manifestations, ranging from asymptomatic pulmonary lesions to disseminated central nervous system infections. The incidence of pulmonary cryptococcosis (PC) has rapidly increased in recent years, with an increasing proportion of non-human immunodeficiency virus-infected and immunocompetent patients making its diagnosis challenging. If not properly recognized, PC can lead to systemic dissemination and high mortality rates. Early diagnosis and treatment can improve the prognosis. This study summarizes the clinical features of three immunocompetent children with PC who presented with chest pain to raise clinicians' awareness of the disease and reduce mortality.
CASE SUMMARY
Three male pediatric patients in good health were hospitalized because of chest pain without cough or fever. Chest computed tomography (CT) revealed pleural-based nodules and consolidation with cavitation. A lung biopsy was performed in one case, and Cryptococcus was cultured from the pathological tissues. Cryptococcus was detected in the alveolar lavage fluid, and serum Cryptococcus capsular(C. capsular) polysaccharide antigen was positive in one case, and the other case was positive for serum C. capsular polysaccharide. All patients received oral fluconazole treatment. Follow-up chest CT scans after six months showed significant resolution of the lesions.
CONCLUSION
PC can also occur in immunocompetent children. When encountering children with chest pain only in the clinic, one should be vigilant about PC, promptly complete the relevant examinations, and avoid misdiagnosis.
Core Tip: Pulmonary cryptococcosis is a relatively rare pediatric pulmonary fungal infection. It usually occurs in immunocompromised children but may also occur in immunocompetent children. It can be complicated by central nervous system cryptococcosis or can occur alone. Pulmonary cryptococcal infection has no specific clinical features, and its diagnosis is difficult. If we do not pay sufficient attention to it, it can be easily missed or misdiagnosed, which can be life-threatening. Early diagnosis and timely initiation of antifungal therapy can improve disease prognosis.
