A Case of Disseminated Cryptococcosis with Mediastinal Lymphadenitis Diagnosed by EBUS-TBNA

Abstract

Background. Immunocompromised patients with cryptococcosis present a variety of image findings, rarely mediastinal and hilar lymphadenopathy, while immunocompetent patients present mostly pulmonary nodules. Case. A 20-year-old man receiving chemotherapy for acute lymphoid leukemia developed persistent fever with mediastinal and left hilar lymphadenopathy. He underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the mediastinal lymph node which revealed the presence of yeast-like funguses, while serum cryptococcal antigen was positive. In addition to these, meningitis was confirmed by central spinal fluid examination. These findings led to a diagnosis of disseminated cryptococcosis with lymphadenitis. He responded to induction therapy with liposomal amphotericin B plus flucytosine and had an uneventful course after changing to maintenance therapy with fluconazole. Conclusion. We suggest that EBUS-TBNA and serum cryptococcal antigen aid in diagnosing cryptococcosis in immunocompromised patients with mediastinal and hilar lymphadenopathy.