Mediastinal Cryptococcosis Secondary to Pulmonary Cryptococcosis Diagnosed by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Abstract

Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful tool for diagnosing mediastinal lymphadenopathies, such as metastatic lung cancer or sarcoidosis, and the utility of EBUS-TBNA in diagnosing infectious disease has recently been reported. We encountered a case in which cryptococcosis was diagnosed using EBUS-TBNA. Case. The patient was a 75-year-old man. In X-4 year, he developed cryptococcal meningitis during steroid therapy for immunoglobulin G4-related kidney disease. Liposomal amphotericin B and itraconazole were administered for cryptococcal meningitis until November, X-1 year. In May X year, he was referred to our department due to an enlarged subcarinal lymph node and a nodule in the left S⁶ on computed tomography. ¹⁸F-fluorodeoxy glucose-positron emission tomography showed high uptake by both lesions. We first performed a transbronchial lung biopsy for the left S⁶ nodule, but no diagnosis could be reached. We then performed EBUS-TBNA for the subcarinal lymph node, and cryptococcosis was diagnosed pathologically. After restarting itraconazole, both the subcarinal lymph node and the left S⁶ nodule decreased in size, and pulmonary cryptococcosis with mediastinal lymphadenitis was diagnosed. Results. EBUS-TBNA was useful in diagnosing mediastinal cryptococcosis. Conclusion. EBUS-TBNA may prove useful in diagnosing mediastinal lymphadenopathy from cryptococcosis.