Clinical characteristics and diagnostic strategies of pulmonary cryptococcosis: an analysis of 24 cases

Abstract

Objective To analyze the clinical features of pulmonary cryptococcosis and discuss its diagnostic strategies. Methods A total of 24 cases of pulmonary cryptococcosis admitted in our hospital from February 2012 to July 2019 were recruited, and their clinical data were collected. The clinical features and diagnosis were analyzed retrospectively. Results Only 4 of the 24 patients had immunosuppressive related diseases. Their common clinical symptoms included cough, expectoration, chest pain, etc., and 9 of them had no symptoms. Common chest imaging manifestations were nodular shadow in 13 cases, mass shadow in 4 cases and mixed lesion in 7 cases. The characteristic chest CT manifestations were mainly mixed lesion, halo sign, subpleural lesion and proximal bronchial ventilation sign. Of the 21 cases tested for cryptococcus antigen, 20 were positive (95.2%, 20/21); Of the 15 patients who underwent histopathological examination, 12 were positive (80%, 12/15), and 1 of them was positive in tissue culture etiology. For the 10 patients who were only positive to cryptococcus antigen or histopathologically, fluconazole treatment was effective to 9 of them. Conclusion Pulmonary cryptococcosis without immunosuppression is common and has nonspecific clinical symptoms mostly. Clinical diagnosis can be made based on clinical symptoms, imaging features, cryptococcal antigen and histopathological positivity of the patients. Fluconazole diagnostic therapy is helpful for diagnosis when there is only one positivity to cryptococcal antigen or histopathology.

Keywords

• pulmonary cryptococcosis
• clinical features
• radiology
• cryptococcal antigen
• diagnostic strategy