2019 Volume 93 Issue 2 Pages 139-142
A 71-year-old woman who was being treated for dermatomyositis with a corticosteroid developed multiple lung nodules. A biopsy from the right middle lung lobe revealed a lung adenocarcinoma harboring the EGFR mutation. During chemotherapy with gefitinib, she suddenly presented with acute respiratory failure. Chest computed tomography did not reveal any abnormalities other than pulmonary nodules, which are signs of metastasis of lung cancer, so we could not determine the cause of respiratory failure. She died within four days after the onset of respiratory failure. An autopsy revealed pulmonary cryptococcosis consisting of multiple lung nodules and intracapillary cryptococci in multiple organs, in addition to the right middle lobe lung adenocarcinoma accompanied with bone metastasis. Intracapillary cryptococci are a rare pathological condition resulting from disseminated cryptococcosis. Intracapillary cryptococci could lead to acute respiratory failure by obstruction of pulmonary capillaries, and would be difficult to diagnose using computed tomography.
