Two Cases with Primary Pulmonary Cryptococcosis Diagnosed by Transbronchial Biopsy

Abstract

In recent years, secondary pulmonary cryptococcosis has not only developed in immunosuppressive conditions, but also primary case have been increasingly reported. During the past two years we experienced two cases of primary pulmonary cryptococcosis which were diagnosed by transbronchial lung biopsy.
A 73-year-old female, farmer, was admitted to our department because of abnormal shadows on chest roentgenogram without any subjective symptom on January 1977. Chest roentgenogram taken on admission revealed a solitary dense mass, 3.5×4.5cm in size with a slightly irregular margin in the right upper lung field. Air-bronchograms were seen in the tomograms. On February 1977, surgical resection was carried out after confirmation of diagnosis of cryptococcosis by transbronchial biopsy.
An 18-year-old male student was referred to our department because of an abnormal shadow on chest roentgenogram taken in a routine medical examination on university entrance in May 1979. He was asymptomatic. Chest roentgenogram on admission showed an infiltrative lesion, about 5cm in diameter with cavitation accompanied by slightly irregular walls. Diagnosis was made by transbronchial biopsy from the right B⁹a. He was given 600mg miconazole per day intravenously for 17 days, then 6 grams 5-FC orally per day until the present. The pulmonary lesion has become smaller.
It seems very important to immediately obtain material from the affected area transbronchially without hesitation for the early diagnosis of cryptococcosis because of the difficulty in treating this disease.