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Abstract

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Article in Japanese

Case Report

A case of pulmonary cryptococcosis with multiple nodular lesions and hypercalcemia

Shiho Yamakoshia,b  Motochika Tanakadateb  Masateru Kawabataa,b 

aDepartment of Respiratory Medicine, Tokyo Medical University
bDepartment of Pulmonary and Critical Care Medicine, Toranomon Hospital, Kajigaya

ABSTRACT

A 91-year-old woman was admitted to our hospital in July 2008 with fever and confusion. Chest radiography indicated multiple infiltrative shadows in the middle and lower lung fields bilaterally, and a computed tomogram (CT) of the chest showed multiple nodular lesions. The patient was suspected to have bacterial pneumonia and was treated with antibacterial agent; however, her condition did not improve. Serum laboratory test results demonstrated marked hypercalcemia, undetectable levels of parathyroid hormone and parathyroid hormone-related protein, and 1,25-dihydroxyvitamin D3 levels in the high-normal range. A CT-guided needle biopsy was performed, and a Grocott-Gomori methenamine-silver nitrate stain of a biopsy specimen from the right lower pulmonary lobe showed a yeast-like fungus. Cryptococcus neoformans was confirmed by culture, and primary pulmonary cryptococcosis was diagnosed. Her serum cryptococcal antigen titer was positive at 1:8,192. The patient was treated with fluconazole, and her symptoms, multiple nodular lesions, and serum laboratory findings improved.

KEYWORDS

Pulmonary cryptococcosis  Cryptococcus neoformans  Sarcoid lesion  Hypercalcemia  CT-guided needle biopsy 

Received 19 Apr 2014 / Accepted 18 Sep 2014

AJRS, 4(1): 91-95, 2015

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