Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2020; 8(7): 1295-1300
Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1295
Pleural effusion in an immunocompetent host with cryptococcal pneumonia: A case report
Huan-Huan Wu, Yan-Xiao Chen, Shuang-Yan Fang
Huan-Huan Wu, Shuang-Yan Fang, Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Yan-Xiao Chen, Department of Evidence-base Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Author contributions: Wu HH was the patient’s Physician, reviewed the literature and contributed to manuscript drafting; Chen YX analyzed and interpreted the imaging findings; Fang SY was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: An informed consent statement was obtained from the reported patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Huan-Huan Wu, MD, Doctor, Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, No. 60, Wuning West Road, Dongyang 322100, Zhejiang Province, China. huanhuan871002@163.com
Received: December 10, 2019
Peer-review started: December 10, 2019
First decision: October 25, 2019
Revised: March 6, 2020
Accepted: March 27, 2020
Article in press: March 27, 2020
Published online: April 6, 2020
Processing time: 117 Days and 18.8 Hours
Abstract
BACKGROUND

Pulmonary cryptococcosis is an opportunistic infection that mainly occurs among immunocompromised patients although it can sometimes occur in immunocompetent individuals. However, the imaging findings of pulmonary cryptococcosis in immunocompetent hosts differ from those in immunosuppressed patients. In addition, the most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules. Cavities and the halo sign are, however, prevalent in immunosuppressed patients. In immunocompetent patients, lung consolidation, pleural effusion or cavities are scarce.

CASE SUMMARY

A 29-year-old Asian male was admitted to our hospital with complaints of cough and fever that had persisted for a month. As a chest computed tomography scan showed consolidation in his left lower lobe, he was initially diagnosed with pneumonia and received antibiotic treatment. A second review of the chest computed tomography image revealed multiple cavities and pleural effusion. Flexible fiberoptic bronchoscopy was subsequently performed, bronchoalveolar lavage fluid and serum cryptococcal antigen tests were positive. Cryptococcus capsules were observed in bronchoalveolar lavage fluid ink stain. Histopathological examination of a percutaneous lung biopsy from the left lower lobe further revealed granulomatous inflammation, and periodic acid-Schiff staining showed red-colored yeast walls, signifying pulmonary cryptococcosis. The patient was then treated with a daily dose of fluconazole (0.4 g), but the cough and fever still persisted. We therefore changed treatment to voriconazole (0.2 g, twice a day), and the patient’s clinical outcome was satisfactory.

CONCLUSION

Although rare, clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.

Keywords: Pulmonary cryptococcosis; Immunocompetent; Computed tomography; Pleural effusion; Imaging findings; Case report

Core tip: The most common imaging findings of isolated pulmonary cryptococcosis are single or multiple nodules located in the peripheral lung field. Cavities and pleural effusion are scarce in immunocompetent patients. In this study, we report a case of isolated cryptococcal pneumonia in an immunocompetent patient without underlying diseases, but exhibiting rare radiologic findings of pleural effusion and cavities. Although rare, clinicians should not disregard the possibility of cavities and pleural effusion occurring in immunocompetent hosts without underlying diseases.