2016 Volume 30 Issue 2 Pages 229-235
A 46-year-old woman was referred to our hospital due to an abnormal chest shadow detected during a medical examination. Chest CT revealed a nodule of 0.7 cm in diameter at the right upper lobe. For diagnosis and treatment, lung wedge resection was performed and the pathological examination revealed pulmonary cryptococcosis covered by inflammatory granulation tissue, but no apparent fungus body was detected outside the inflammatory granulation tissue. Since the immunocompetence of the patient was normal and serum antigen for Cryptococcus became negative after the resection, adjuvant antifungal drug therapy was not administered. Four months after surgery, the patient presented with complaints of headache and fever. Chest CT revealed a large mass of 5 cm in diameter at the right upper lobe, and Cryptococcus antigens in both serum and cerebrospinal fluid were elevated. The patient was diagnosed with recurrence of pulmonary cryptococcosis concomitant with meningitis. After treatment with antifungal drugs, the patient underwent a completion right upper lobectomy. After 1 year of adjuvant antifungal drug therapy, the patient has remained disease-free. We present this very rare case of pulmonary cryptococcosis that developed a recurrent focus and meningitis after the resection of a single small pulmonary nodule of Cryptococcus in a patient with normal immunocompetence and negative for serum Cryptococcus antigen, and who was not initially considered as a candidate for adjuvant antifungal drug therapy.
