Cryptococcus infection with asymptomatic diffuse pulmonary disease in an immunocompetent patient: A case report

Table 1 Cryptococcus infection in immunocompetent patients

Case	Sex, age	Medical history	Diagnostic modalities	Clinical presentation	Imaging	Immuno-assay	Histopathology	Treatment
1, this report	M36	Good condition	CT-guided percutaneous core needle biopsy	None	Pulmonary nodules and a mass in both lungs; PET-CT showed the SUVmax of the cryptococcal lesions fluctuated from 4.8 to 19.1	Negative	Granulomatous inflammation; GMS was positive and PSA was negative	Fluconazole
2, Bavishi et al[20]	F67	Hypertension and cholelithiasis	CT-guided percutaneous core needle biopsy	Recurrent dry cough for 4 yr	Multiple pulmonary nodules in both the lower lobes	Serology cryptococcal antigen titer of 1: 32	FMS staining was strongly positive	Intravenous amphotericin B for 2 d and then changed to fluconazole
3, Zhou et al[21]	M44	Good condition	Brochoscopy	3-mo history of cough, hemoptysis	Pulmonary nodules in both lungs; PET-CT showed the SUVmax of the cryptococcal lesions fluctuated from 9.86 to 10.99	Titer of more than 1: 1, 280	GMS stain was positive; Culture of bronchoscopy with brush was positive	Amphotericin B
4, Marroni et al[22]	F21	Good condition	CT-guided percutaneous core needle biopsy	Rigors, fever, dyspnoea, dry cough, and chest pain	A round mass in the lung	Positive at a titre of 1: 256	GMS and PSA staining was positive	Fluconazole
5, Oliveira et al[5]	M64	Arterial hypertension	Fiberoptic bronchoscopy with bronchoalveolar lavage	Fever, weakness, anorexia, headache, dyspnea, cough, purulent sputum production, and disorientation	Pulmonary spherical mass lesion, 5 cm in diameter	The CSF cryptococcal antigen titer was 1: 4096 with a serum titer of 1:2048	MGG staininh was positive	Amphotericin B
6, Ruan et al[12]	M68	Good condition	Surgical drainage	Progressive multiple abscesses, fever, lower extremity weakness, and urinary retention	Pulmonary abscess formation and multiple destruction of vertebral bodies	Negative	Culture revealed; Cryptococcus neoformans; India ink staining	Itraconazole; Fluorocytosine; Fluconazole

FMS: Fontana-Masson silver; CT: Computed tomography; PET: Positron emission tomography; GMS: Grocott’s methenamine-silver staining; CSF: Cerebrospinal fluid; COPD: Chronic obstructive pulmonary disease; PAS: Periodic acid-Schiff staining; MGG: May-Grunwald Giemsa.