Chest Infections: Chest Infections I |

Pulmonary Cryptococcosis Among 3 Immunocompetent Patients Misdiagnosed as Bacterial Pneumonia and Pulmonary Tuberculosis FREE TO VIEW

Yi Liang, MD; Ying Shen, MD; Jianquan Zhang, MD; Xiaoning Zhong, MD
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Guangxi Medical University, Nanning, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A114. doi:10.1016/j.chest.2016.02.119
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SESSION TITLE: Chest Infections I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Pulmonary cryptococcosis (PC) has been recognized an opportunistic infection of lungs caused by Cryptococcusspecies complex, which rarely affected healthy hosts and typically present clinical symptoms as mild or even asymptomatic, Compared to mild patients, those with critical symptoms are reported to demonstrate acute or sub-acute onset, fast evolution and pneumonia-like manifestations that all easily mixed with other pulmonary diseases and complicated the differential diagnosis. We reported 3 immunocompetent patients with severe PC who had been misdiagnosed and treated wrongly for one or two months before the right diagnosis was eventually established.

CASE PRESENTATION: A case study of three HIV-negative patients with pulmonary cryptococcosis, each of whom exhibited classical clinical picture of bacterial pneumonia or pulmonary tuberculosis and was initially misdiagnosed and managed with antibiotics or anti-TB therapy until pathological examination confirmed the definitive diagnosis of pulmonary cryptococcosis.

DISCUSSION: The three cases all had been initially misdiagnosed and been gone through long courses from initial clinical symptoms to confirmative tissue diagnosis, varying from one to three months. Besides, each of them experienced unnecessary antibiotics, even anti-TB treatment. Pretty high rate for initial misdiagnosis on immunocompetent patients with PC was commonly reported in domestic and oversea studies, In absence of explicit etiology evidences, various symptoms and confused radiographic manifestations by PC always lead to mazy options in differential diagnosis and make reaching definite diagnosis like a tricky gamble in real clinical settings. we suggest that early percutaneous translung biopsy should be considered, in particular when patients revealed multi-lesions or extensively cross-lobes infiltrates with exudation and/or cavitation, accompanying a frustrated anti-biotic treatment.

CONCLUSIONS: PC in immunocompetent patients could also present acute onset, severe symptoms and extensive infiltrates or cavitation in pulmonary parenchyma and interstitial tissue radiographically, which frequently lead to extremely high misdiagnosis rate and unnecessary medical responses harmful to patients. Early pathology examination may be significant to confirm the diagnosis as soon as possible and to assure timely anti-fungus therapy.

Reference #1: 1. Núñez M, Peacock JE Jr, Chin R Jr (2000) Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. Chest 118:527-534.

Reference #2: 9. Zhang Y, Li N, Zhang Y, Li H, Chen X, Wang S, Zhang X, Zhang R, Xu J, Shi J, Yung RC (2012) Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J 40:1191-1200

Reference #3: 10. Ye F, Xie JX, Zeng QS, Chen GQ, Zhong SQ, Zhong NS (2012) Retrospective Analysis of 76 Immunocompetent Patients with Primary Pulmonary Cryptococcosis. Lung 190:339-346

DISCLOSURE: The following authors have nothing to disclose: Yi Liang, Ying Shen, Jianquan Zhang, Xiaoning Zhong

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