Fig 1.
Chest CT findings of HIV-infected patients with cryptococcal infection and pulmonary abnormalities.
SN, solitary nodule; MN, multiple nodules; PE, pleural effusions; PI, pneumonic infiltrates.
Fig 2.
A representative case of laboratory-confirmed pulmonary cryptococcosis.
A 49-years-old man presented to hospital with Lymphadenopathy for 3 months and fever for 1 month. He had HIV infection with a CD4 count of 108 cells/μL. Serum cryptococcal antigen titer was 1:40. Serum galactomannan assay was negative. Chest CT scan demonstrated multiple pulmonary nodules (A, arrow). Lung biopsy showed encapsulated yeast-like fungal cells consistent with cryptococcal infection(arrows in B, alcian blue stain).
Table 1.
Etiologies of pulmonary lesions.
Fig 3.
A representative case of clinical deduction of pulmonary cryptococcosis.
A 47-year-old woman presented to hospital with fever, cough and shortness of breath. She was confirmed of HIV infection with a CD4 count of 60 cells/μL. The serum cryptococcal antigen titer was 1:16. Lumbar puncture was performed and there was no evidence of cryptococcal meningitis. A chest CT scan showed diffuse ground-glass opacities (DGO). Also on the Chest CT, there was a small nodule (A, arrow). She was given empirical treatment with co-trimoxazole (1440 mg, every eight hours) for pneumocystis pneumonia, and methylprednisolone as an adjunctive therapy. A chest CT scan after 3 weeks showed nearly complete resolution of the DGO; however, the nodular lesion progressed(B, arrow). The patient then received secondary prophylaxis for pneumocystis pneumonia with co-trimoxazole(960 mg/d) and treated with fluconazole (400mg/d). A follow-up CT scan after seventeen days of fluconazole treatment showed partial resolution of the nodule (C, arrow). Taken together, the nodule lesion was attributed to pulmonary cryptpcoccosis, while the DGO were related to pneumocystis pneumonia.