Pulmonary cryptococcal infection presenting with multiple lung nodules

Abstract

Pulmonary infections from the environmental fungus Cryptococcus gattii (C. gattii) are notable for cryptococcomas, which are usually solitary and can be very large. As with infections with Cryptococcus neoformans (C. neoformans) patients can have concomitant cryptococcal meningitis; however, unlike for C. neoformans, infections with C. gattii often occur in immunocompetent patients. The highest published incidence of C. gattii infection has been in the Indigenous Australian population of Arnhem Land in the tropical north of the country. More recently C. gattii has been responsible for outbreaks of cryptococcosis in the Pacific Northwest of Canada and the United States of America (USA). A previously healthy Indigenous male from Arnhem Land presented with pulmonary cryptococcosis with chest imaging showing >50 bilateral lung nodules. This unusual occurrence was attributed to probable inhalation of fungal elements from prior use of a high-pressure leaf blower to clear eucalyptus and other debris in a remote bush camp.