Lung Mass as a Presenting Sign of Disseminated Cryptococcus

Abstract

Cryptococcosis is an invasive fungal disease that most commonly affects immunocompromised individuals, typically causing pulmonary and Central Nervous System (CNS) symptoms. The fungus that causes cryptococcosis, Cryptococcus, is globally disseminated and often transmitted through bird droppings. The two most frequent and pertinent species responsible for clinical infections in humans include Cryptococcus neoformans, which has been known to cause the majority of cryptococcosis globally until recently, during which Cryptococcus gattii has been identified and reported more frequently. A 54-year-old male with a history of renal transplant on chronic immunosuppressants and type 2 diabetes mellitus was found to have multiple lung masses within the right upper and right lower lobes. He had also been experiencing syncope and multiple falls with worsening headache, tinnitus, diplopia, and ongoing weight loss. The patient underwent a percutaneous biopsy of the lung mass in addition to a Lumbar Puncture (LP), which revealed a positive cryptococcus antigen confirmed to be C. gattii. The patient was started on amphotericin B and flucytosine to treat cryptococcal meningitis. Despite treatment, his condition continued to worsen, necessitating daily therapeutic LP and temporary placement of a lumbar drain. Once his symptoms were better managed, he was discharged from the hospital but has continued to have serial LPs outpatient while concurrently taking fluconazole to prevent reaccumulation of CSF and recurrence of symptoms. The purpose of this report is to describe the unique presentation of disseminated Cryptococcus gattii infection identified as a lung mass and subsequent management of cryptococcosis.